Provider Demographics
NPI:1093866030
Name:GILMER DRUG COMPANY INC.
Entity Type:Organization
Organization Name:GILMER DRUG COMPANY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST IN CHARGE
Authorized Official - Prefix:
Authorized Official - First Name:TARA
Authorized Official - Middle Name:
Authorized Official - Last Name:RATCLIFF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-376-4530
Mailing Address - Street 1:413 19TH STREET ENSLEY
Mailing Address - Street 2:ENSLEY
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35218-1601
Mailing Address - Country:US
Mailing Address - Phone:205-787-4671
Mailing Address - Fax:205-788-0450
Practice Address - Street 1:413 19TH STREET ENSLEY
Practice Address - Street 2:ENSLEY
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35218-1601
Practice Address - Country:US
Practice Address - Phone:205-787-4671
Practice Address - Fax:205-788-0450
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-16
Last Update Date:2019-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3336C0003XSuppliersPharmacyCommunity/Retail PharmacyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL100000189Medicaid