Provider Demographics
NPI:1134159122
Name:DOWNEY DRUG ALEXANDRIA, LLC
Entity type:Organization
Organization Name:DOWNEY DRUG ALEXANDRIA, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VP OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:GRAHAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:256-820-4540
Mailing Address - Street 1:658 VALLEY CUB DR
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:AL
Mailing Address - Zip Code:36250-4200
Mailing Address - Country:US
Mailing Address - Phone:256-820-4540
Mailing Address - Fax:256-820-7545
Practice Address - Street 1:658 VALLEY CUB DR
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:AL
Practice Address - Zip Code:36250-4200
Practice Address - Country:US
Practice Address - Phone:256-820-4540
Practice Address - Fax:256-820-7545
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-04
Last Update Date:2016-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
AL1121353336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL100003316Medicaid
1988438OtherPK
AL100003316Medicaid