Provider Demographics
NPI:1073511465
Name:BORDEN COMPANY LLC
Entity Type:Organization
Organization Name:BORDEN COMPANY LLC
Other - Org Name:BORDEN FAMILY PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PIC
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:N
Authorized Official - Last Name:BORDEN
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:256-734-7535
Mailing Address - Street 1:3190 AL HIGHWAY 157
Mailing Address - Street 2:
Mailing Address - City:CULLMAN
Mailing Address - State:AL
Mailing Address - Zip Code:35058-0686
Mailing Address - Country:US
Mailing Address - Phone:256-734-7535
Mailing Address - Fax:256-734-1056
Practice Address - Street 1:3190 AL HIGHWAY 157
Practice Address - Street 2:
Practice Address - City:CULLMAN
Practice Address - State:AL
Practice Address - Zip Code:35058-0686
Practice Address - Country:US
Practice Address - Phone:256-734-7535
Practice Address - Fax:256-734-1056
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-11
Last Update Date:2021-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 333600000X
AL1115833336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
051552665OtherMEDICARE IMMUNIZER
AL100003075Medicaid
0126676OtherNCPDP PROVIDER IDENTIFICATION NUMBER
AL009927880Medicaid