Provider Demographics
NPI:1831188010
Name:MR DISCOUNT DRUGS OF BUTLER
Entity type:Organization
Organization Name:MR DISCOUNT DRUGS OF BUTLER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:MR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:KEITH
Authorized Official - Last Name:MANLEY
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:205-459-2990
Mailing Address - Street 1:604 E PUSHMATAHA ST
Mailing Address - Street 2:
Mailing Address - City:BUTLER
Mailing Address - State:AL
Mailing Address - Zip Code:36904-2620
Mailing Address - Country:US
Mailing Address - Phone:205-459-2990
Mailing Address - Fax:
Practice Address - Street 1:604 E PUSHMATAHA ST
Practice Address - Street 2:
Practice Address - City:BUTLER
Practice Address - State:AL
Practice Address - Zip Code:36904-2620
Practice Address - Country:US
Practice Address - Phone:205-459-2990
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL107036333600000X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered333600000XSuppliersPharmacy
Not Answered3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL510-54581OtherBCBS-ALABAMA
AL510-54581OtherBCBS-ALABAMA