Provider Demographics
NPI:1407061526
Name:MILLRY DRUGS, LLC
Entity Type:Organization
Organization Name:MILLRY DRUGS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:251-846-6208
Mailing Address - Street 1:PO BOX 199
Mailing Address - Street 2:
Mailing Address - City:MILLRY
Mailing Address - State:AL
Mailing Address - Zip Code:36558-0199
Mailing Address - Country:US
Mailing Address - Phone:251-846-6290
Mailing Address - Fax:
Practice Address - Street 1:30282 HWY 17 N
Practice Address - Street 2:
Practice Address - City:MILLRY
Practice Address - State:AL
Practice Address - Zip Code:36558
Practice Address - Country:US
Practice Address - Phone:251-846-6290
Practice Address - Fax:251-846-6208
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-11
Last Update Date:2021-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 333600000X
AL1111913336C0003X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL100002969Medicaid
1994009OtherPK
0324320005Medicare NSC