Provider Demographics
NPI:1376619205
Name:DEUEL DRUG STORE INC
Entity Type:Organization
Organization Name:DEUEL DRUG STORE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER-MANAGER-PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:CHARLEY
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:DEUEL
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:251-478-7607
Mailing Address - Street 1:2710 SPRINGHILL AVE
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36607-2918
Mailing Address - Country:US
Mailing Address - Phone:251-478-7607
Mailing Address - Fax:251-478-7498
Practice Address - Street 1:2710 SPRINGHILL AVE
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36607-2918
Practice Address - Country:US
Practice Address - Phone:251-478-7607
Practice Address - Fax:251-478-7498
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-24
Last Update Date:2008-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1031673336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL0702360001Medicare NSC
AL0702360001Medicare ID - Type UnspecifiedALABAMA