Provider Demographics
NPI:1730779588
Name:DRUG STORE AT STEVENSON ALABAMA INC
Entity type:Organization
Organization Name:DRUG STORE AT STEVENSON ALABAMA INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:EMILY
Authorized Official - Middle Name:PITTMAN
Authorized Official - Last Name:LAYNE
Authorized Official - Suffix:
Authorized Official - Credentials:DOCTOR OF PHARMACY
Authorized Official - Phone:931-235-2000
Mailing Address - Street 1:205 KENTUCKY AVE
Mailing Address - Street 2:
Mailing Address - City:STEVENSON
Mailing Address - State:AL
Mailing Address - Zip Code:35772-3103
Mailing Address - Country:US
Mailing Address - Phone:256-437-6500
Mailing Address - Fax:256-437-6501
Practice Address - Street 1:205 KENTUCKY AVE
Practice Address - Street 2:
Practice Address - City:STEVENSON
Practice Address - State:AL
Practice Address - Zip Code:35772-3103
Practice Address - Country:US
Practice Address - Phone:256-437-6500
Practice Address - Fax:256-437-6501
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-25
Last Update Date:2021-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL115028OtherSTATE PHARMACY LICENSE