Provider Demographics
NPI:1669253654
Name:LUDS PHARMACY
Entity type:Organization
Organization Name:LUDS PHARMACY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:TAI
Authorized Official - Middle Name:
Authorized Official - Last Name:BOLAJI
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD MBA/MHCA
Authorized Official - Phone:334-778-7091
Mailing Address - Street 1:172 LUDS WAY,
Mailing Address - Street 2:
Mailing Address - City:DOTHAN , ALABAMA
Mailing Address - State:AL
Mailing Address - Zip Code:36330-0803
Mailing Address - Country:US
Mailing Address - Phone:334-475-0646
Mailing Address - Fax:334-888-8445
Practice Address - Street 1:172 LUDS WAY,
Practice Address - Street 2:SUITE 100
Practice Address - City:DOTHAN , ALABAMA
Practice Address - State:AL
Practice Address - Zip Code:36330-0803
Practice Address - Country:US
Practice Address - Phone:334-475-0646
Practice Address - Fax:334-888-8445
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-06
Last Update Date:2025-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No3336C0002XSuppliersPharmacyClinic Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies