Organization
FAYETTE PHARMACY INC
Active
Other names
Joe Golden Drug
Organization subpart
No
Provider details
NPI number
Authorized official
SUMMER WILSON (OWNER/PHARMACIST)
(205) 712-1685
Entity
Organization
Contact information
Practice address
13532 HIGHWAY 96, MILLPORT, AL 35576-2522
(205) 662-3817
(205) 662-4757
Mailing address
PO BOX 408, MILLPORT, AL 35576-0408
(205) 662-3817
(205) 662-4757
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
105645
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2138253
PK
—
Enumeration date
08/28/2007
Last updated
02/20/2017
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