Provider Demographics
NPI:1104831734
Name:KILLEN DRUGS INC
Entity Type:Organization
Organization Name:KILLEN DRUGS INC
Other - Org Name:KILLEN CORNER DRUGS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRES
Authorized Official - Prefix:
Authorized Official - First Name:JULIUS
Authorized Official - Middle Name:
Authorized Official - Last Name:SPRY
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:256-757-2166
Mailing Address - Street 1:PO BOX 57
Mailing Address - Street 2:
Mailing Address - City:KILLEN
Mailing Address - State:AL
Mailing Address - Zip Code:35645-0057
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1621 HIGHWAY 72
Practice Address - Street 2:
Practice Address - City:KILLEN
Practice Address - State:AL
Practice Address - Zip Code:35645-9142
Practice Address - Country:US
Practice Address - Phone:256-757-2166
Practice Address - Fax:256-757-9580
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-30
Last Update Date:2008-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1058103336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
0107854OtherOTHER ID NUMBER-COMMERCIAL NUMBER
AL100000822Medicaid