Provider Demographics
NPI:1992276547
Name:PIKE DRUG COMPANY LLC
Entity type:Organization
Organization Name:PIKE DRUG COMPANY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KHADIJA
Authorized Official - Middle Name:F
Authorized Official - Last Name:CALDWELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:334-536-0205
Mailing Address - Street 1:132 S MAIN ST STE 1
Mailing Address - Street 2:
Mailing Address - City:BRUNDIDGE
Mailing Address - State:AL
Mailing Address - Zip Code:36010-1809
Mailing Address - Country:US
Mailing Address - Phone:334-536-0205
Mailing Address - Fax:334-536-0206
Practice Address - Street 1:132 S MAIN ST STE 1
Practice Address - Street 2:
Practice Address - City:BRUNDIDGE
Practice Address - State:AL
Practice Address - Zip Code:36010-1809
Practice Address - Country:US
Practice Address - Phone:334-536-0205
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-07
Last Update Date:2022-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL227761Medicaid