Provider Demographics
NPI:1093885097
Name:DOUGLAS DISCOUNT PHARMACY INC
Entity Type:Organization
Organization Name:DOUGLAS DISCOUNT PHARMACY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:MR
Authorized Official - First Name:JIMMY
Authorized Official - Middle Name:BRUCE
Authorized Official - Last Name:GANN
Authorized Official - Suffix:JR
Authorized Official - Credentials:RPH
Authorized Official - Phone:256-593-1750
Mailing Address - Street 1:PO BOX 28
Mailing Address - Street 2:
Mailing Address - City:DOUGLAS
Mailing Address - State:AL
Mailing Address - Zip Code:35964
Mailing Address - Country:US
Mailing Address - Phone:256-593-1750
Mailing Address - Fax:256-593-1711
Practice Address - Street 1:9461 AL HIGHWAY 75 STE A
Practice Address - Street 2:
Practice Address - City:HORTON
Practice Address - State:AL
Practice Address - Zip Code:35980-8399
Practice Address - Country:US
Practice Address - Phone:256-593-1750
Practice Address - Fax:256-593-1711
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-08
Last Update Date:2020-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL100002809Medicaid
AL100002809Medicaid
AL1141950001Medicare NSC