Provider Demographics
NPI:1225022346
Name:JIM MYERS DRUG, INC.
Entity Type:Organization
Organization Name:JIM MYERS DRUG, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ROGER
Authorized Official - Middle Name:P
Authorized Official - Last Name:MYERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-556-3800
Mailing Address - Street 1:3325 UNIVERSITY BLVD E
Mailing Address - Street 2:
Mailing Address - City:TUSCALOOSA
Mailing Address - State:AL
Mailing Address - Zip Code:35404-4339
Mailing Address - Country:US
Mailing Address - Phone:205-556-3800
Mailing Address - Fax:205-556-0142
Practice Address - Street 1:3325 UNIVERSITY BLVD E
Practice Address - Street 2:
Practice Address - City:TUSCALOOSA
Practice Address - State:AL
Practice Address - Zip Code:35404-4339
Practice Address - Country:US
Practice Address - Phone:205-556-3800
Practice Address - Fax:205-556-0142
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL105655333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL0133060001Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER