Provider Demographics
NPI:1912098484
Name:DEG PHARMACY INC
Entity Type:Organization
Organization Name:DEG PHARMACY INC
Other - Org Name:ADDISON DISCOUNT PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER PRES MGR
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:GODBEE
Authorized Official - Suffix:
Authorized Official - Credentials:R PH
Authorized Official - Phone:256-747-6342
Mailing Address - Street 1:PO BOX 180 30910 HWY 278
Mailing Address - Street 2:
Mailing Address - City:ADDISON
Mailing Address - State:AL
Mailing Address - Zip Code:35540
Mailing Address - Country:US
Mailing Address - Phone:256-747-6342
Mailing Address - Fax:256-747-6106
Practice Address - Street 1:30910 HWY 278
Practice Address - Street 2:
Practice Address - City:ADDISON
Practice Address - State:AL
Practice Address - Zip Code:35540
Practice Address - Country:US
Practice Address - Phone:256-747-6342
Practice Address - Fax:256-747-6106
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-27
Last Update Date:2008-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL111247333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
0117362OtherNCPDP NABP
0117362OtherNCPDP NABP