Provider Demographics
NPI:1508267667
Name:MONTGOMERY DRUG COMPANY, INC.
Entity Type:Organization
Organization Name:MONTGOMERY DRUG COMPANY, INC.
Other - Org Name:ADAMS DRUGS CHANTILLY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACY MGR
Authorized Official - Prefix:MR
Authorized Official - First Name:CHRIS
Authorized Official - Middle Name:
Authorized Official - Last Name:PHUNG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:334-272-0802
Mailing Address - Street 1:9168 EASTCHASE PKWY
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36117-6883
Mailing Address - Country:US
Mailing Address - Phone:334-386-7068
Mailing Address - Fax:334-386-7069
Practice Address - Street 1:9168 EASTCHASE PKWY
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36117-6883
Practice Address - Country:US
Practice Address - Phone:334-386-7068
Practice Address - Fax:334-386-7069
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-09
Last Update Date:2014-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1144083336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy