Provider Demographics
NPI:1699233114
Name:YOUNGS DRUG STORE LLC
Entity type:Organization
Organization Name:YOUNGS DRUG STORE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANGER
Authorized Official - Prefix:
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:STANLEY
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:256-449-2372
Mailing Address - Street 1:PO BOX 67
Mailing Address - Street 2:
Mailing Address - City:LINEVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:36266-0067
Mailing Address - Country:US
Mailing Address - Phone:256-396-5632
Mailing Address - Fax:256-396-5142
Practice Address - Street 1:24460 HIGHWAY 48
Practice Address - Street 2:
Practice Address - City:WOODLAND
Practice Address - State:AL
Practice Address - Zip Code:36280-5204
Practice Address - Country:US
Practice Address - Phone:256-449-2372
Practice Address - Fax:256-449-2379
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:YOUNG'S DRUG STORE LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-03-04
Last Update Date:2022-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL230482Medicaid