Provider Demographics
NPI:1902203524
Name:TUSCALOOSA DRUG NORTH, LLC
Entity Type:Organization
Organization Name:TUSCALOOSA DRUG NORTH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:DANIEL
Authorized Official - Last Name:SWEATT
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:205-409-6410
Mailing Address - Street 1:13620 HIGHWAY 43 N
Mailing Address - Street 2:SUITE A
Mailing Address - City:NORTHPORT
Mailing Address - State:AL
Mailing Address - Zip Code:35475-4411
Mailing Address - Country:US
Mailing Address - Phone:205-409-6410
Mailing Address - Fax:205-409-6413
Practice Address - Street 1:13620 HIGHWAY 43 N
Practice Address - Street 2:SUITE A
Practice Address - City:NORTHPORT
Practice Address - State:AL
Practice Address - Zip Code:35475-4411
Practice Address - Country:US
Practice Address - Phone:205-409-6410
Practice Address - Fax:205-409-6413
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TUSCALOOSA DRUG COMPANY, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-11-25
Last Update Date:2014-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1144373336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy