Provider Demographics
NPI:1336129808
Name:T AND K PHARMACY, INC.
Entity Type:Organization
Organization Name:T AND K PHARMACY, INC.
Other - Org Name:BERRY PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:KENNETH
Authorized Official - Last Name:LLOYD
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:205-689-4777
Mailing Address - Street 1:PO BOX 441
Mailing Address - Street 2:
Mailing Address - City:BERRY
Mailing Address - State:AL
Mailing Address - Zip Code:35546-0441
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:31 DEPOT ST
Practice Address - Street 2:
Practice Address - City:BERRY
Practice Address - State:AL
Practice Address - Zip Code:35546-2086
Practice Address - Country:US
Practice Address - Phone:205-689-4777
Practice Address - Fax:205-689-4778
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-19
Last Update Date:2008-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL110447333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL100002786Medicaid