Provider Demographics
NPI:1174674030
Name:CITY DRUG STORE, INC.
Entity Type:Organization
Organization Name:CITY DRUG STORE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:HOSEA
Authorized Official - Middle Name:R
Authorized Official - Last Name:DAILEY
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:251-578-1050
Mailing Address - Street 1:110 LEWIS ST
Mailing Address - Street 2:
Mailing Address - City:EVERGREEN
Mailing Address - State:AL
Mailing Address - Zip Code:36401-3317
Mailing Address - Country:US
Mailing Address - Phone:251-578-1050
Mailing Address - Fax:
Practice Address - Street 1:110 LEWIS ST
Practice Address - Street 2:
Practice Address - City:EVERGREEN
Practice Address - State:AL
Practice Address - Zip Code:36401-3317
Practice Address - Country:US
Practice Address - Phone:251-578-1050
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL102440332B00000X, 333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Not Answered333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL0106345OtherNABP
AL0106345OtherNCPDP
AL0106345OtherNCPDP