Provider Demographics
NPI:1427384577
Name:SHOALS FAMILY PHARMACY GROUP INC
Entity Type:Organization
Organization Name:SHOALS FAMILY PHARMACY GROUP INC
Other - Org Name:THE DRUG SHOP OF RUSSELLVILLE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:JEREMY
Authorized Official - Middle Name:
Authorized Official - Last Name:LANE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:256-810-3331
Mailing Address - Street 1:455 UNDERWOOD RD
Mailing Address - Street 2:
Mailing Address - City:RUSSELLVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35653-4111
Mailing Address - Country:US
Mailing Address - Phone:256-332-5545
Mailing Address - Fax:256-332-5582
Practice Address - Street 1:318 JACKSON AVE S
Practice Address - Street 2:SUITE 1
Practice Address - City:RUSSELLVILLE
Practice Address - State:AL
Practice Address - Zip Code:35653-2207
Practice Address - Country:US
Practice Address - Phone:256-332-8550
Practice Address - Fax:256-332-8081
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-26
Last Update Date:2015-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1133063336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2122271OtherPK