Provider Demographics
NPI:1104941749
Name:BIG C DISCOUNT DRUGS
Entity type:Organization
Organization Name:BIG C DISCOUNT DRUGS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:LEWIS
Authorized Official - Middle Name:ETHEREDGE
Authorized Official - Last Name:REDDITT
Authorized Official - Suffix:II
Authorized Official - Credentials:PHARMACIST
Authorized Official - Phone:251-653-0720
Mailing Address - Street 1:5808B HIGHWAY 90
Mailing Address - Street 2:
Mailing Address - City:THEODORE
Mailing Address - State:AL
Mailing Address - Zip Code:36582-1643
Mailing Address - Country:US
Mailing Address - Phone:251-653-0720
Mailing Address - Fax:251-653-0748
Practice Address - Street 1:5808B HIGHWAY 90
Practice Address - Street 2:
Practice Address - City:THEODORE
Practice Address - State:AL
Practice Address - Zip Code:36582-1643
Practice Address - Country:US
Practice Address - Phone:251-653-0720
Practice Address - Fax:251-653-0748
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL7228183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL1000001973Medicaid