Provider Demographics
NPI:1922067966
Name:IDER DISCOUNT DRUGS INC
Entity Type:Organization
Organization Name:IDER DISCOUNT DRUGS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:RODNEY
Authorized Official - Middle Name:HUGH
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:256-657-5151
Mailing Address - Street 1:10705 AL HIGHWAY 75
Mailing Address - Street 2:
Mailing Address - City:IDER
Mailing Address - State:AL
Mailing Address - Zip Code:35981-4627
Mailing Address - Country:US
Mailing Address - Phone:256-657-5151
Mailing Address - Fax:256-657-2275
Practice Address - Street 1:10705 AL HIGHWAY 75
Practice Address - Street 2:
Practice Address - City:IDER
Practice Address - State:AL
Practice Address - Zip Code:35981-4627
Practice Address - Country:US
Practice Address - Phone:256-657-5151
Practice Address - Fax:256-657-2275
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-20
Last Update Date:2015-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL111553332B00000X, 333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL100003067Medicaid
AL1283470001Medicare NSC