Provider Demographics
NPI:1235567355
Name:FOODLAND PHARMACY SB LLC
Entity Type:Organization
Organization Name:FOODLAND PHARMACY SB LLC
Other - Org Name:FOODLAND PHARMACY SB, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACY MANAGER/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:KINSLEY
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:256-259-1011
Mailing Address - Street 1:1402 COUNTY PARK RD STE 1
Mailing Address - Street 2:
Mailing Address - City:SCOTTSBORO
Mailing Address - State:AL
Mailing Address - Zip Code:35769-3968
Mailing Address - Country:US
Mailing Address - Phone:256-259-1011
Mailing Address - Fax:256-259-1138
Practice Address - Street 1:1402 COUNTY PARK RD STE 1
Practice Address - Street 2:
Practice Address - City:SCOTTSBORO
Practice Address - State:AL
Practice Address - Zip Code:35769-3968
Practice Address - Country:US
Practice Address - Phone:256-259-1011
Practice Address - Fax:256-259-1138
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-29
Last Update Date:2022-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
AL1142333336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2142791OtherPK
AL154030Medicaid