Provider Demographics
NPI:1750435277
Name:DAVIS DRUG CO INC
Entity type:Organization
Organization Name:DAVIS DRUG CO INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT PHARMACIST
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:T
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:JR
Authorized Official - Credentials:RPH
Authorized Official - Phone:205-669-6713
Mailing Address - Street 1:111 SO MAIN ST PO BOX 1065
Mailing Address - Street 2:
Mailing Address - City:COLUMBIANA
Mailing Address - State:AL
Mailing Address - Zip Code:35051
Mailing Address - Country:US
Mailing Address - Phone:205-669-6713
Mailing Address - Fax:205-669-7351
Practice Address - Street 1:111 SO MAIN ST
Practice Address - Street 2:
Practice Address - City:COLUMBIANA
Practice Address - State:AL
Practice Address - Zip Code:35051
Practice Address - Country:US
Practice Address - Phone:205-669-6713
Practice Address - Fax:205-669-7651
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DAVIS DRUG CO INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-01-22
Last Update Date:2008-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL103080333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL10000298Medicaid
AL50278OtherDME
AL100000298Medicaid
AL50278OtherAL MEDICAID DME
AL0105711Medicare UPIN
AL0724500001Medicare NSC
AL50278OtherAL MEDICAID DME
AL10000298Medicaid