Provider Demographics
NPI:1003950742
Name:ALAMO-CITY DRUG
Entity Type:Organization
Organization Name:ALAMO-CITY DRUG
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER-PHARMAACIST
Authorized Official - Prefix:
Authorized Official - First Name:MELVIN
Authorized Official - Middle Name:ROY
Authorized Official - Last Name:YORK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:731-696-2266
Mailing Address - Street 1:8 N CAVALIER DR
Mailing Address - Street 2:
Mailing Address - City:ALAMO
Mailing Address - State:TN
Mailing Address - Zip Code:38001-6468
Mailing Address - Country:US
Mailing Address - Phone:731-696-2266
Mailing Address - Fax:731-696-2204
Practice Address - Street 1:8 N CAVALIER DR
Practice Address - Street 2:
Practice Address - City:ALAMO
Practice Address - State:TN
Practice Address - Zip Code:38001-6468
Practice Address - Country:US
Practice Address - Phone:731-696-2266
Practice Address - Fax:731-696-2204
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1231333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3550508Medicaid
TN3550508Medicaid