Provider Demographics
NPI:1396850285
Name:DOWNEY DRUG ANNISTON LLC
Entity Type:Organization
Organization Name:DOWNEY DRUG ANNISTON LLC
Other - Org Name:DOWNEY DRUG
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:JOHNNIE
Authorized Official - Middle Name:
Authorized Official - Last Name:ELLIS
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:256-236-1531
Mailing Address - Street 1:2427 AL HIGHWAY 202
Mailing Address - Street 2:
Mailing Address - City:ANNISTON
Mailing Address - State:AL
Mailing Address - Zip Code:36201-5324
Mailing Address - Country:US
Mailing Address - Phone:256-237-9426
Mailing Address - Fax:256-237-4352
Practice Address - Street 1:2427 AL HIGHWAY 202 STE A
Practice Address - Street 2:
Practice Address - City:ANNISTON
Practice Address - State:AL
Practice Address - Zip Code:36201-5391
Practice Address - Country:US
Practice Address - Phone:256-237-9426
Practice Address - Fax:256-237-4352
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-20
Last Update Date:2018-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
AL1112083336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
1988447OtherPK
AL100003717Medicaid