Provider Demographics
NPI:1477614535
Name:T & C PHARMACY INC
Entity Type:Organization
Organization Name:T & C PHARMACY INC
Other - Org Name:T AND C PHARMACY, INC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:
Authorized Official - Last Name:VAUGHAN
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:334-453-4517
Mailing Address - Street 1:PO BOX 594
Mailing Address - Street 2:
Mailing Address - City:OPP
Mailing Address - State:AL
Mailing Address - Zip Code:36467-0594
Mailing Address - Country:US
Mailing Address - Phone:334-493-4517
Mailing Address - Fax:334-493-2538
Practice Address - Street 1:101 PARISH AVE
Practice Address - Street 2:
Practice Address - City:OPP
Practice Address - State:AL
Practice Address - Zip Code:36467-1613
Practice Address - Country:US
Practice Address - Phone:334-493-4517
Practice Address - Fax:334-493-2538
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-13
Last Update Date:2017-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336L0003X
AL1097353336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
1991203OtherPK
AL100003233Medicaid
1991203OtherPK