Provider Demographics
NPI:1285105668
Name:COTTRELL'S HOMETOWN PHARMACY PC
Entity type:Organization
Organization Name:COTTRELL'S HOMETOWN PHARMACY PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:D
Authorized Official - Last Name:COTTRELL
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:251-809-1010
Mailing Address - Street 1:PO BOX 259
Mailing Address - Street 2:
Mailing Address - City:BREWTON
Mailing Address - State:AL
Mailing Address - Zip Code:36427-0259
Mailing Address - Country:US
Mailing Address - Phone:251-809-1010
Mailing Address - Fax:251-241-0020
Practice Address - Street 1:305 FORREST AVE
Practice Address - Street 2:
Practice Address - City:EAST BREWTON
Practice Address - State:AL
Practice Address - Zip Code:36426-2620
Practice Address - Country:US
Practice Address - Phone:251-809-1010
Practice Address - Fax:251-241-0020
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-11
Last Update Date:2019-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy