Provider Demographics
NPI:1891873147
Name:CLOVERLAND DRUGS, INC
Entity Type:Organization
Organization Name:CLOVERLAND DRUGS, INC
Other - Org Name:CAROL VILLA PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:GLENN
Authorized Official - Last Name:SAALWAECHTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:334-279-7413
Mailing Address - Street 1:5350 ATLANTA HWY # C
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36109-3324
Mailing Address - Country:US
Mailing Address - Phone:334-279-7413
Mailing Address - Fax:334-279-7418
Practice Address - Street 1:5350 ATLANTA HWY # C
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36109-3324
Practice Address - Country:US
Practice Address - Phone:334-279-7413
Practice Address - Fax:334-279-7418
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-02
Last Update Date:2012-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL111672183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL100002819Medicaid
AL100002819Medicaid