Provider Demographics
NPI:1922300292
Name:LOWES PHARMACY LLC
Entity Type:Organization
Organization Name:LOWES PHARMACY LLC
Other - Org Name:LOWE'S PHARMACY, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:R.PH.
Authorized Official - Prefix:
Authorized Official - First Name:BRENT
Authorized Official - Middle Name:
Authorized Official - Last Name:FULLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:334-864-9868
Mailing Address - Street 1:339 9TH AVE SW
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:AL
Mailing Address - Zip Code:36862-2803
Mailing Address - Country:US
Mailing Address - Phone:334-864-7781
Mailing Address - Fax:334-864-0096
Practice Address - Street 1:339 9TH AVE SW
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:AL
Practice Address - Zip Code:36862-2803
Practice Address - Country:US
Practice Address - Phone:334-864-7781
Practice Address - Fax:334-864-0096
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-18
Last Update Date:2017-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
AL1062753336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL125291Medicaid
2128363OtherPK
AL125291Medicaid