Provider Demographics
NPI:1275686800
Name:PLEASANT GROVE DRUGS INC.
Entity Type:Organization
Organization Name:PLEASANT GROVE DRUGS INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:ANDREW
Authorized Official - Last Name:RUDOLPH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-744-9400
Mailing Address - Street 1:611 PLEASANT GROVE RD
Mailing Address - Street 2:
Mailing Address - City:PLEASANT GROVE
Mailing Address - State:AL
Mailing Address - Zip Code:35127-2801
Mailing Address - Country:US
Mailing Address - Phone:205-744-9400
Mailing Address - Fax:
Practice Address - Street 1:611 PLEASANT GROVE RD
Practice Address - Street 2:
Practice Address - City:PLEASANT GROVE
Practice Address - State:AL
Practice Address - Zip Code:35127-2801
Practice Address - Country:US
Practice Address - Phone:205-744-9400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-18
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1115913336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
0129393OtherNABP
BP6525248OtherDEA