Provider Demographics
NPI:1053670687
Name:BERRY DISCOUNT APOTHECARY
Entity type:Organization
Organization Name:BERRY DISCOUNT APOTHECARY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:R
Authorized Official - Last Name:BOLLING
Authorized Official - Suffix:JR
Authorized Official - Credentials:RPH
Authorized Official - Phone:205-689-4777
Mailing Address - Street 1:31 DEPOT ST
Mailing Address - Street 2:P.O. BOX 424
Mailing Address - City:BERRY
Mailing Address - State:AL
Mailing Address - Zip Code:35546-2086
Mailing Address - Country:US
Mailing Address - Phone:205-689-4777
Mailing Address - Fax:205-689-4778
Practice Address - Street 1:31 DEPOT ST
Practice Address - Street 2:
Practice Address - City:BERRY
Practice Address - State:AL
Practice Address - Zip Code:35546-2086
Practice Address - Country:US
Practice Address - Phone:205-689-4777
Practice Address - Fax:205-689-4778
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-16
Last Update Date:2012-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy