Provider Demographics
NPI:1669551339
Name:DARBYS VILLAGE PHARMACY INC
Entity type:Organization
Organization Name:DARBYS VILLAGE PHARMACY INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:
Authorized Official - Last Name:DARBY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:334-222-8825
Mailing Address - Street 1:301 E 3 NOTCH ST
Mailing Address - Street 2:STE A
Mailing Address - City:ANDALUSIA
Mailing Address - State:AL
Mailing Address - Zip Code:36420-3124
Mailing Address - Country:US
Mailing Address - Phone:334-222-8825
Mailing Address - Fax:334-222-2761
Practice Address - Street 1:301 E 3 NOTCH ST
Practice Address - Street 2:STE A
Practice Address - City:ANDALUSIA
Practice Address - State:AL
Practice Address - Zip Code:36420-3124
Practice Address - Country:US
Practice Address - Phone:334-222-8825
Practice Address - Fax:334-222-2761
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-03
Last Update Date:2015-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
AL1111873336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
0127971OtherNCPDP PROVIDER IDENTIFICATION NUMBER
AL100002945Medicaid