Provider Demographics
NPI:1043328537
Name:SHORTER DRUGS, BOATNERWERKS, INC DBA
Entity Type:Organization
Organization Name:SHORTER DRUGS, BOATNERWERKS, INC DBA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/PHARMACIST
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:L
Authorized Official - Last Name:BOATNER
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:334-264-1110
Mailing Address - Street 1:PO BOX 70369
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36107-0369
Mailing Address - Country:US
Mailing Address - Phone:334-264-1110
Mailing Address - Fax:334-262-0748
Practice Address - Street 1:17150 US HIGHWAY 80 W
Practice Address - Street 2:
Practice Address - City:SHORTER
Practice Address - State:AL
Practice Address - Zip Code:36075-3930
Practice Address - Country:US
Practice Address - Phone:334-725-9282
Practice Address - Fax:334-725-9285
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1128023336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL0133823OtherNCPDP