Provider Demographics
NPI:1821092230
Name:BOAZ DISCOUNT DRUGS INC
Entity Type:Organization
Organization Name:BOAZ DISCOUNT DRUGS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:CARY
Authorized Official - Middle Name:DALE
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:III
Authorized Official - Credentials:
Authorized Official - Phone:256-593-6546
Mailing Address - Street 1:PO BOX 573
Mailing Address - Street 2:
Mailing Address - City:BOAZ
Mailing Address - State:AL
Mailing Address - Zip Code:35957-0573
Mailing Address - Country:US
Mailing Address - Phone:256-593-6546
Mailing Address - Fax:256-593-3137
Practice Address - Street 1:10460 ALABAMA HWY 168, SUITE 1
Practice Address - Street 2:
Practice Address - City:BOAZ
Practice Address - State:AL
Practice Address - Zip Code:35957-1951
Practice Address - Country:US
Practice Address - Phone:256-593-6546
Practice Address - Fax:256-593-3137
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-13
Last Update Date:2011-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1016453336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL100001098Medicaid
AL0101143OtherNABP#
AL0101143OtherNABP#