Provider Demographics
NPI:1477668499
Name:MONTGOMERY CITY DRUG INC
Entity Type:Organization
Organization Name:MONTGOMERY CITY DRUG INC
Other - Org Name:MONTGOMERY CITY DRUG
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HAMP
Authorized Official - Middle Name:
Authorized Official - Last Name:RUSSELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:334-263-6144
Mailing Address - Street 1:11 DEXTER AVE
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36104-3514
Mailing Address - Country:US
Mailing Address - Phone:334-263-6144
Mailing Address - Fax:334-263-9897
Practice Address - Street 1:11 DEXTER AVE
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36104-3514
Practice Address - Country:US
Practice Address - Phone:334-263-6144
Practice Address - Fax:334-263-9897
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-20
Last Update Date:2011-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1024153336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
0137198OtherNCPDP PROVIDER IDENTIFICATION NUMBER