Provider Demographics
NPI:1508832932
Name:WIREGRASS DRUGS INC
Entity Type:Organization
Organization Name:WIREGRASS DRUGS INC
Other - Org Name:MEDICAL ARTS PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CORPORATE SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:TRACY
Authorized Official - Middle Name:C
Authorized Official - Last Name:ALLIGOOD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:229-435-4571
Mailing Address - Street 1:PO BOX 72188
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:GA
Mailing Address - Zip Code:31708-2188
Mailing Address - Country:US
Mailing Address - Phone:229-435-4571
Mailing Address - Fax:229-317-7706
Practice Address - Street 1:313 E PUSHMATAHA ST
Practice Address - Street 2:
Practice Address - City:BUTLER
Practice Address - State:AL
Practice Address - Zip Code:36904-2533
Practice Address - Country:US
Practice Address - Phone:205-459-3710
Practice Address - Fax:205-459-3970
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-25
Last Update Date:2023-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL110125183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL00105418OtherNABP
AL009999460Medicaid
AL100001121Medicaid
AL4313640001Medicare NSC