Provider Demographics
NPI:1114144292
Name:FDC, INC
Entity Type:Organization
Organization Name:FDC, INC
Other - Org Name:FAIRFAX DRUG CO.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:E
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:334-756-2305
Mailing Address - Street 1:89 TRAMMELL BLOCK
Mailing Address - Street 2:
Mailing Address - City:VALLEY
Mailing Address - State:AL
Mailing Address - Zip Code:36854-4903
Mailing Address - Country:US
Mailing Address - Phone:334-756-2305
Mailing Address - Fax:334-756-9142
Practice Address - Street 1:89 TRAMMELL BLOCK
Practice Address - Street 2:
Practice Address - City:VALLEY
Practice Address - State:AL
Practice Address - Zip Code:36854-4903
Practice Address - Country:US
Practice Address - Phone:334-756-2305
Practice Address - Fax:334-756-9142
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-19
Last Update Date:2012-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL259332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL009943186Medicaid