Provider Demographics
NPI:1154462414
Name:GROSS DRUG CO INC
Entity Type:Organization
Organization Name:GROSS DRUG CO INC
Other - Org Name:GROSS DRUG CO INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TAMMY
Authorized Official - Middle Name:
Authorized Official - Last Name:HADDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-686-9945
Mailing Address - Street 1:PO BOX 205
Mailing Address - Street 2:
Mailing Address - City:PARRISH
Mailing Address - State:AL
Mailing Address - Zip Code:35580-0205
Mailing Address - Country:US
Mailing Address - Phone:205-686-9945
Mailing Address - Fax:205-686-9993
Practice Address - Street 1:6456 AL HWY 269
Practice Address - Street 2:
Practice Address - City:PARRISH
Practice Address - State:AL
Practice Address - Zip Code:35580
Practice Address - Country:US
Practice Address - Phone:205-686-9945
Practice Address - Fax:205-686-9993
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-09
Last Update Date:2017-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
AL1099913336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL100003675Medicaid
1990076OtherPK