Provider Demographics
NPI:1215084561
Name:PAYLESS DRUGS, INC.
Entity type:Organization
Organization Name:PAYLESS DRUGS, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ARTHUR
Authorized Official - Middle Name:BOYD
Authorized Official - Last Name:ENNIS
Authorized Official - Suffix:JR
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:205-647-0515
Mailing Address - Street 1:4901 GARY AVE
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:AL
Mailing Address - Zip Code:35064-1348
Mailing Address - Country:US
Mailing Address - Phone:205-785-4343
Mailing Address - Fax:205-785-4344
Practice Address - Street 1:4901 GARY AVE
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:AL
Practice Address - Zip Code:35064-1348
Practice Address - Country:US
Practice Address - Phone:205-785-4343
Practice Address - Fax:205-785-4344
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PAYLESS DRUGS, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-01-05
Last Update Date:2020-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1038253336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL100002155Medicaid