Provider Demographics
NPI:1235255498
Name:COLLEGE CITY DRUG
Entity Type:Organization
Organization Name:COLLEGE CITY DRUG
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:BRADFORD
Authorized Official - Middle Name:ROGERS
Authorized Official - Last Name:STURIGS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:334-683-6166
Mailing Address - Street 1:304 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:AL
Mailing Address - Zip Code:36756-2332
Mailing Address - Country:US
Mailing Address - Phone:334-683-6166
Mailing Address - Fax:334-683-9621
Practice Address - Street 1:304 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:AL
Practice Address - Zip Code:36756-2332
Practice Address - Country:US
Practice Address - Phone:334-683-6166
Practice Address - Fax:334-683-9621
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL102640332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51050425OtherBC BS OF ALABAMA
AL51050425OtherBC BS OF ALABAMA