Provider Demographics
NPI:1497864037
Name:LEMOX-CLOVERDALE DRUGS INC
Entity Type:Organization
Organization Name:LEMOX-CLOVERDALE DRUGS INC
Other - Org Name:LEMOX-CLOVERDALE DRUG
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ALVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:KEARLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-428-4146
Mailing Address - Street 1:PO BOX 647
Mailing Address - Street 2:
Mailing Address - City:BESSEMER
Mailing Address - State:AL
Mailing Address - Zip Code:35021-0647
Mailing Address - Country:US
Mailing Address - Phone:205-428-4146
Mailing Address - Fax:205-428-2664
Practice Address - Street 1:130 9TH ST S
Practice Address - Street 2:
Practice Address - City:BESSEMER
Practice Address - State:AL
Practice Address - Zip Code:35020-6392
Practice Address - Country:US
Practice Address - Phone:205-428-4146
Practice Address - Fax:205-428-2664
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-29
Last Update Date:2011-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1060803336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL100000475Medicaid
0114835OtherNCPDP PROVIDER IDENTIFICATION NUMBER