Provider Demographics
NPI:1144334137
Name:A & L INC
Entity type:Organization
Organization Name:A & L INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:STEVE
Authorized Official - Middle Name:
Authorized Official - Last Name:BASORE
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:903-675-5040
Mailing Address - Street 1:419 S PALESTINE ST
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:TX
Mailing Address - Zip Code:75751-2511
Mailing Address - Country:US
Mailing Address - Phone:903-675-5040
Mailing Address - Fax:903-675-7442
Practice Address - Street 1:419 S PALESTINE ST
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:TX
Practice Address - Zip Code:75751-2511
Practice Address - Country:US
Practice Address - Phone:903-675-5040
Practice Address - Fax:903-675-7442
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-18
Last Update Date:2017-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336L0003X
TX64353336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2102817OtherPK
TX142204Medicaid