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Organization

ATHENS CREEKSIDE DRUGS, LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MR. MARK KENT JACKSON (OWNER/PHARMACIST)
(256) 232-8274
Entity
Organization

Contact information

Practice address
605 US HIGHWAY 31 S, SUITE D, ATHENS, AL 35611-3645
(256) 232-8274
(256) 232-2029
Mailing address
605 US HIGHWAY 31 S, SUITE D, ATHENS, AL 35611-3645
(256) 232-8274
(256) 232-2029

Taxonomy

Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
111879
AL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
10003175
AL
Enumeration date
08/29/2006
Last updated
01/26/2011
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