Provider Demographics
NPI:1154461200
Name:SAND DRUG INC
Entity Type:Organization
Organization Name:SAND DRUG INC
Other - Org Name:PAY-LESS DRIVE-IN PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/RPH IN CHARGE
Authorized Official - Prefix:
Authorized Official - First Name:BLAKE
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:GOWEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:256-353-5011
Mailing Address - Street 1:1206 7TH ST SE
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:AL
Mailing Address - Zip Code:35601-3338
Mailing Address - Country:US
Mailing Address - Phone:256-353-5011
Mailing Address - Fax:256-355-5152
Practice Address - Street 1:1206 7TH ST SE
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:AL
Practice Address - Zip Code:35601-3338
Practice Address - Country:US
Practice Address - Phone:256-353-5011
Practice Address - Fax:256-355-5152
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-07
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1075413336C0003X, 3336C0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL0111790OtherNCPDP NUMBER
AL100003745Medicaid
AL107541OtherALABAMA PHARMACY LICENSE
AL107541OtherALABAMA PHARMACY LICENSE