Provider Demographics
NPI:1114401973
Name:FAYETTE DOWNTOWN PHARMACY, INC
Entity Type:Organization
Organization Name:FAYETTE DOWNTOWN PHARMACY, INC
Other - Org Name:FAYETTE DOWNTOWN PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:KATIE
Authorized Official - Middle Name:
Authorized Official - Last Name:WAKEFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:205-412-7150
Mailing Address - Street 1:PO BOX 666
Mailing Address - Street 2:
Mailing Address - City:FAYETTE
Mailing Address - State:AL
Mailing Address - Zip Code:35555-0666
Mailing Address - Country:US
Mailing Address - Phone:205-932-4513
Mailing Address - Fax:205-932-9203
Practice Address - Street 1:1128 2ND AVE NE
Practice Address - Street 2:
Practice Address - City:FAYETTE
Practice Address - State:AL
Practice Address - Zip Code:35555-1739
Practice Address - Country:US
Practice Address - Phone:205-932-4513
Practice Address - Fax:205-932-9203
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-18
Last Update Date:2023-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy