Provider Demographics
NPI:1336293414
Name:GREEN VALLEY DRUGS CO., INC.
Entity Type:Organization
Organization Name:GREEN VALLEY DRUGS CO., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:BOX
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-822-1151
Mailing Address - Street 1:1915 HOOVER CT
Mailing Address - Street 2:
Mailing Address - City:HOOVER
Mailing Address - State:AL
Mailing Address - Zip Code:35226-3606
Mailing Address - Country:US
Mailing Address - Phone:205-822-1151
Mailing Address - Fax:205-822-1183
Practice Address - Street 1:1915 HOOVER CT
Practice Address - Street 2:
Practice Address - City:HOOVER
Practice Address - State:AL
Practice Address - Zip Code:35226-3606
Practice Address - Country:US
Practice Address - Phone:205-822-1151
Practice Address - Fax:205-822-1183
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-23
Last Update Date:2008-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1047503336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL100002527Medicaid
AL100002527Medicaid