Provider Demographics
NPI:1588674170
Name:PEOPLES DRUGS & VARIETY,INC.
Entity Type:Organization
Organization Name:PEOPLES DRUGS & VARIETY,INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER-PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:TRACY
Authorized Official - Middle Name:CHESTEEN
Authorized Official - Last Name:WIX
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:256-359-6242
Mailing Address - Street 1:8260 HIGHWAY 72
Mailing Address - Street 2:PO BOX J
Mailing Address - City:CHEROKEE
Mailing Address - State:AL
Mailing Address - Zip Code:35616-4402
Mailing Address - Country:US
Mailing Address - Phone:256-359-6242
Mailing Address - Fax:256-359-4652
Practice Address - Street 1:8260 HIGHWAY 72
Practice Address - Street 2:
Practice Address - City:CHEROKEE
Practice Address - State:AL
Practice Address - Zip Code:35616-4402
Practice Address - Country:US
Practice Address - Phone:256-359-6242
Practice Address - Fax:256-359-4652
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-08
Last Update Date:2010-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1076703336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51098591OtherBLUE CROSS BLUE SHIELD OF ALABAMA
AL009999850Medicaid
AL0187370001Medicare NSC