Provider Demographics
NPI:1033319579
Name:BUBBAS MEDICINE SHOP INC
Entity Type:Organization
Organization Name:BUBBAS MEDICINE SHOP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:MAURY
Authorized Official - Last Name:YOUNG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:334-749-3426
Mailing Address - Street 1:512 2ND AVE
Mailing Address - Street 2:
Mailing Address - City:OPELIKA
Mailing Address - State:AL
Mailing Address - Zip Code:36801-4316
Mailing Address - Country:US
Mailing Address - Phone:334-749-3426
Mailing Address - Fax:334-742-0757
Practice Address - Street 1:512 2ND AVE
Practice Address - Street 2:
Practice Address - City:OPELIKA
Practice Address - State:AL
Practice Address - Zip Code:36801-4316
Practice Address - Country:US
Practice Address - Phone:334-749-3426
Practice Address - Fax:334-742-0757
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BUBBAS MEDICINE SHOP INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-07-23
Last Update Date:2008-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51525636OtherBCBS
AL51525636OtherBCBS