Organization
NEW GRAND BAY PHARMACY, LLC
Active
Other names
Grand Bay Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
MR. CHARLES D COTTRELL RPH (PRESIDENT)
(251) 865-5555
Entity
Organization
Contact information
Practice address
10067 GRAND BAY WILMER RD S, GRAND BAY, AL 36541-5003
(251) 865-5555
(251) 865-3785
Mailing address
PO BOX 129, GRAND BAY, AL 36541-0129
(251) 865-1040
(251) 865-1041
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
113415
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
121508
—
AL
Enumeration date
07/28/2010
Last updated
10/18/2024
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