Provider Demographics
NPI:1669553673
Name:GENTRY DRUGS INC
Entity type:Organization
Organization Name:GENTRY DRUGS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER AND PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:GENTRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-373-6688
Mailing Address - Street 1:551 MEMORIAL PKWY NE
Mailing Address - Street 2:
Mailing Address - City:ALICEVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35442-2743
Mailing Address - Country:US
Mailing Address - Phone:205-373-6688
Mailing Address - Fax:205-373-1666
Practice Address - Street 1:551 MEMORIAL PKWY NE
Practice Address - Street 2:
Practice Address - City:ALICEVILLE
Practice Address - State:AL
Practice Address - Zip Code:35442-2743
Practice Address - Country:US
Practice Address - Phone:205-373-6688
Practice Address - Fax:205-373-1666
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-17
Last Update Date:2017-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
AL1081523336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL100001715Medicaid
1990777OtherPK
3978350001Medicare NSC