Provider Demographics
NPI:1083631717
Name:SUMITON DISCOUNT DRUG INC
Entity type:Organization
Organization Name:SUMITON DISCOUNT DRUG INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ERNEST
Authorized Official - Middle Name:
Authorized Official - Last Name:MAURY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-648-3296
Mailing Address - Street 1:PO BOX 326
Mailing Address - Street 2:
Mailing Address - City:SUMITON
Mailing Address - State:AL
Mailing Address - Zip Code:35148
Mailing Address - Country:US
Mailing Address - Phone:205-648-3296
Mailing Address - Fax:205-648-3297
Practice Address - Street 1:1595 MAIN ST
Practice Address - Street 2:
Practice Address - City:SUMITON
Practice Address - State:AL
Practice Address - Zip Code:35148
Practice Address - Country:US
Practice Address - Phone:205-648-3296
Practice Address - Fax:205-648-3297
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-17
Last Update Date:2008-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL109320333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL0109795OtherNABP