Provider Demographics
NPI:1407806177
Name:CGM INC
Entity Type:Organization
Organization Name:CGM INC
Other - Org Name:MEDICINE SHOPPE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:RICHARDSON
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:256-329-7780
Mailing Address - Street 1:1144 AIRPORT DR
Mailing Address - Street 2:
Mailing Address - City:ALEXANDER CITY
Mailing Address - State:AL
Mailing Address - Zip Code:35010
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1144 AIRPORT DR
Practice Address - Street 2:
Practice Address - City:ALEXANDER CITY
Practice Address - State:AL
Practice Address - Zip Code:35010
Practice Address - Country:US
Practice Address - Phone:256-215-8014
Practice Address - Fax:256-215-8017
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-11
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1128133336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL100003704Medicaid
0133746OtherOTHER ID NUMBER-COMMERCIAL NUMBER
0133746OtherOTHER ID NUMBER-COMMERCIAL NUMBER
AL510G730024Medicare PIN
0133746OtherOTHER ID NUMBER-COMMERCIAL NUMBER