Provider Demographics
NPI:1568449049
Name:EASTERN VALLEY DRUGS, INC
Entity Type:Organization
Organization Name:EASTERN VALLEY DRUGS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:MR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:E
Authorized Official - Last Name:PRICKETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-425-5258
Mailing Address - Street 1:1310 EASTERN VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:BESSEMER
Mailing Address - State:AL
Mailing Address - Zip Code:35020-8609
Mailing Address - Country:US
Mailing Address - Phone:205-425-5258
Mailing Address - Fax:205-425-1373
Practice Address - Street 1:1310 EASTERN VALLEY RD
Practice Address - Street 2:
Practice Address - City:BESSEMER
Practice Address - State:AL
Practice Address - Zip Code:35020-8609
Practice Address - Country:US
Practice Address - Phone:205-425-5258
Practice Address - Fax:205-425-1373
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EASTERN VALLEY DRUGS, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-12-27
Last Update Date:2012-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL072782183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL000052500Medicaid
AL51052500OtherBLUE CROSS BLUE SHIELD
AL51052500OtherBLUE CROSS BLUE SHIELD