Provider Demographics
NPI:1922116615
Name:J & A PHARMACY INC CENTRE
Entity Type:Organization
Organization Name:J & A PHARMACY INC CENTRE
Other - Org Name:ALACO DISCOUNTY PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JEFF
Authorized Official - Middle Name:S
Authorized Official - Last Name:GRAVES
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:256-927-8539
Mailing Address - Street 1:102 JD SMITH DRIVE
Mailing Address - Street 2:ALACO WAREHOUSE - BUSINESS OFFICE
Mailing Address - City:ATTALLA
Mailing Address - State:AL
Mailing Address - Zip Code:35954-3350
Mailing Address - Country:US
Mailing Address - Phone:256-538-5697
Mailing Address - Fax:256-538-0239
Practice Address - Street 1:1490 CHESNUT BYPASS
Practice Address - Street 2:
Practice Address - City:CENTRE
Practice Address - State:AL
Practice Address - Zip Code:35960
Practice Address - Country:US
Practice Address - Phone:256-927-8539
Practice Address - Fax:256-927-8588
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-25
Last Update Date:2019-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1010533336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL0111497OtherNABP#
AL100001380Medicaid