Provider Demographics
NPI:1679605984
Name:LITTLE DRUG COMPANY, LLC
Entity type:Organization
Organization Name:LITTLE DRUG COMPANY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:LAMAR
Authorized Official - Last Name:BOONE
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:334-295-4270
Mailing Address - Street 1:PO BOX 480999
Mailing Address - Street 2:
Mailing Address - City:LINDEN
Mailing Address - State:AL
Mailing Address - Zip Code:36748-0999
Mailing Address - Country:US
Mailing Address - Phone:334-295-4270
Mailing Address - Fax:334-295-0141
Practice Address - Street 1:310 MAIN ST S
Practice Address - Street 2:
Practice Address - City:LINDEN
Practice Address - State:AL
Practice Address - Zip Code:36748
Practice Address - Country:US
Practice Address - Phone:334-295-4270
Practice Address - Fax:334-295-0141
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-12
Last Update Date:2014-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1124013336C0003X, 3336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL100003556Medicaid
AL100003556Medicaid