NPIMap

Organization Active NPI

Montgomery Drug Company

Doing business as Adams Drugs-Prattville

  • Community/Retail Pharmacy
  • Prattville, AL
National Provider Identifier
1023105665
Registry record updated Feb 10, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
111580 Issued in AL
Legal business name
MONTGOMERY DRUG COMPANY
Doing business as
Adams Drugs-Prattville
Practice address
103 S Memorial Dr
Prattville, AL 36067-3621
Phone
(334) 358-5353
Fax
(334) 358-5352
NPI assigned
Oct 6, 2006
Organization subpart
Yes
Parent organization
MONTGOMERY DRUG COMPANY, INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Feb 10, 2015

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Carl Bledsoe, R. PH.
Title
Pharmacy Manager
Phone
(334) 358-5353

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X 111580 AL
Community/Retail Pharmacy 3336C0003X 111580 AL Primary

Addresses

Primary practice location

103 S Memorial Dr
Prattville, AL 36067-3621

Mailing address

103 S Memorial Dr
Prattville, AL 36067-3621
Phone (334) 358-5353

Other identifiers 1

IdentifierTypeStateIssuer
100003104MedicaidAL

Other names 1

  • Adams Drugs-Prattville Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20160913001314 AL Part B Supplier - Pharmacy 2860648284 9 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Montgomery, AL; Wetumpka, AL; Prattville, AL; Millbrook, AL; Deatsville, AL

Other NPIs on the same Medicare enrollment 9

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
01D2133775Adams Drugs - Prattville103 S Memorial Drive, Prattville, AL 36067Certificate of waiverJul 18, 2027

National Provider Directory

National Provider Directory
Tax ID family
Adams Street Drug Co12 organizations share this tax ID, including this one
Part of
Adams Street Drug Co

Other organizations with this tax ID 11

Organizations that report the same tax identification number in the National Provider Directory.

Locations

103 S Memorial Dr
Prattville, AL 36067
Phone (334) 358-5353

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1160092800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1423526400000",
    "number": "1023105665",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "103 S MEMORIAL DR",
            "city": "PRATTVILLE",
            "state": "AL",
            "postal_code": "360673621",
            "telephone_number": "334-358-5353",
            "fax_number": "334-358-5352"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "103 S MEMORIAL DR",
            "city": "PRATTVILLE",
            "state": "AL",
            "postal_code": "360673621",
            "telephone_number": "334-358-5353",
            "fax_number": "334-358-5352"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MONTGOMERY DRUG COMPANY",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MONTGOMERY DRUG COMPANY, INC",
        "enumeration_date": "2006-10-06",
        "last_updated": "2015-02-10",
        "status": "A",
        "authorized_official_last_name": "BLEDSOE",
        "authorized_official_first_name": "CARL",
        "authorized_official_title_or_position": "PHARMACY MANAGER",
        "authorized_official_telephone_number": "334-358-5353",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "R. PH."
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "AL",
            "license": "111580",
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "AL",
            "license": "111580",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100003104",
            "state": "AL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Adams Drugs-Prattville",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Prattville, AL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 10, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.