Provider Demographics
NPI:1770635021
Name:HANCEVILLE DRUG COMPANY
Entity Type:Organization
Organization Name:HANCEVILLE DRUG COMPANY
Other - Org Name:HANCEVILLE DRUG COMPANY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:
Authorized Official - Last Name:BURKART
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:256-352-4110
Mailing Address - Street 1:101 COMMERCIAL ST SE
Mailing Address - Street 2:
Mailing Address - City:HANCEVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35077-5516
Mailing Address - Country:US
Mailing Address - Phone:256-352-4110
Mailing Address - Fax:256-352-5660
Practice Address - Street 1:101 COMMERCIAL ST SE
Practice Address - Street 2:
Practice Address - City:HANCEVILLE
Practice Address - State:AL
Practice Address - Zip Code:35077-5516
Practice Address - Country:US
Practice Address - Phone:256-352-4110
Practice Address - Fax:256-352-5660
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-17
Last Update Date:2017-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1050103336C0003X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2166648OtherPK
1988738OtherPK