Provider Demographics
NPI:1932282084
Name:ARLEY COUNTRY PHARMACY LLC
Entity Type:Organization
Organization Name:ARLEY COUNTRY PHARMACY LLC
Other - Org Name:ARLEY COUNTRY PHARMACY LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JENELLA
Authorized Official - Middle Name:
Authorized Official - Last Name:BURTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-387-0526
Mailing Address - Street 1:PO BOX 477
Mailing Address - Street 2:
Mailing Address - City:ARLEY
Mailing Address - State:AL
Mailing Address - Zip Code:35541-0477
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6168 COUNTY ROAD 41
Practice Address - Street 2:
Practice Address - City:ARLEY
Practice Address - State:AL
Practice Address - Zip Code:35541-3372
Practice Address - Country:US
Practice Address - Phone:205-295-9290
Practice Address - Fax:205-295-9289
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-23
Last Update Date:2011-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1128713336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
0134128OtherNCPDP PROVIDER IDENTIFICATION NUMBER