Provider Demographics
NPI:1396410551
Name:HURTSBORO DRUGS LLC
Entity Type:Organization
Organization Name:HURTSBORO DRUGS LLC
Other - Org Name:HURTSBORO DRUGS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RYLEN
Authorized Official - Middle Name:
Authorized Official - Last Name:CREWS
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:334-560-1329
Mailing Address - Street 1:PO BOX 327
Mailing Address - Street 2:
Mailing Address - City:HURTSBORO
Mailing Address - State:AL
Mailing Address - Zip Code:36860-0327
Mailing Address - Country:US
Mailing Address - Phone:334-560-1329
Mailing Address - Fax:334-560-1392
Practice Address - Street 1:510 MAIN ST
Practice Address - Street 2:
Practice Address - City:HURTSBORO
Practice Address - State:AL
Practice Address - Zip Code:36860
Practice Address - Country:US
Practice Address - Phone:334-560-1329
Practice Address - Fax:334-560-1392
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-10
Last Update Date:2022-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL276610Medicaid