Provider Demographics
NPI:1245529494
Name:C & R PHARMACY
Entity type:Organization
Organization Name:C & R PHARMACY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:XIULU
Authorized Official - Middle Name:
Authorized Official - Last Name:RUAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:251-478-4900
Mailing Address - Street 1:4682 AIRPORT BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36608-3124
Mailing Address - Country:US
Mailing Address - Phone:251-341-1113
Mailing Address - Fax:251-341-1116
Practice Address - Street 1:4682 AIRPORT BLVD STE A
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36608-3124
Practice Address - Country:US
Practice Address - Phone:251-341-1113
Practice Address - Fax:241-341-1116
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-28
Last Update Date:2012-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3336C0004X
AL1135783336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
0137047OtherNCPDP PROVIDER IDENTIFICATION NUMBER