Provider Demographics
NPI:1396115796
Name:MONTGOMERY DRUG COMPANY INC
Entity type:Organization
Organization Name:MONTGOMERY DRUG COMPANY INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHARMACY MGR
Authorized Official - Prefix:
Authorized Official - First Name:CHRIS
Authorized Official - Middle Name:
Authorized Official - Last Name:PHUNG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:334-538-2484
Mailing Address - Street 1:2175B US HIGHWAY 31 N
Mailing Address - Street 2:
Mailing Address - City:DEATSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:36022-2714
Mailing Address - Country:US
Mailing Address - Phone:334-351-9550
Mailing Address - Fax:334-351-9551
Practice Address - Street 1:2175B US HIGHWAY 31 N
Practice Address - Street 2:
Practice Address - City:DEATSVILLE
Practice Address - State:AL
Practice Address - Zip Code:36022-2714
Practice Address - Country:US
Practice Address - Phone:334-351-9550
Practice Address - Fax:334-351-9551
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-29
Last Update Date:2015-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1145313336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2154362OtherPK