Provider Demographics
NPI:1174723555
Name:THE DRUG STORE CO INC.
Entity type:Organization
Organization Name:THE DRUG STORE CO INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LEE
Authorized Official - Middle Name:E
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-652-9595
Mailing Address - Street 1:108 LAFAYETTE STREET
Mailing Address - Street 2:PO BOX 1246
Mailing Address - City:LIVINGSTON
Mailing Address - State:AL
Mailing Address - Zip Code:35470-0000
Mailing Address - Country:US
Mailing Address - Phone:205-652-9595
Mailing Address - Fax:205-652-6111
Practice Address - Street 1:108 LAFAYETTE STREET
Practice Address - Street 2:
Practice Address - City:LIVINGSTON
Practice Address - State:AL
Practice Address - Zip Code:35470-0000
Practice Address - Country:US
Practice Address - Phone:205-652-9595
Practice Address - Fax:205-652-6111
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-23
Last Update Date:2008-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL112084332BP3500X, 332BX2000X, 332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
No332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL0113011OtherNCPDP
AL510G870005Medicare PIN
0145270001Medicare NSC