Provider Demographics
NPI:1154354181
Name:SAND DRUGS INC
Entity type:Organization
Organization Name:SAND DRUGS INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/ RPH IN CHARGE
Authorized Official - Prefix:
Authorized Official - First Name:BLAKE
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:GOWEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:256-353-5011
Mailing Address - Street 1:1206 7TH ST SE
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:AL
Mailing Address - Zip Code:35601-3338
Mailing Address - Country:US
Mailing Address - Phone:256-353-5011
Mailing Address - Fax:256-355-5152
Practice Address - Street 1:1206 7TH ST SE
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:AL
Practice Address - Zip Code:35601-3338
Practice Address - Country:US
Practice Address - Phone:256-353-5011
Practice Address - Fax:256-355-5152
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-10
Last Update Date:2019-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL000052917Medicaid
AL51531230OtherBLUE CROSS BLUE SHIELD AL
0131210001Medicare ID - Type Unspecified