Fayette Downtown Pharmacy, Inc
Organization Active NPI Community/Retail Pharmacy · Fayette, AL
NPI 1114401973 · NPPES record last updated Aug 3, 2023
Key facts
- NPI
- 1114401973
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Community/Retail Pharmacy 3336C0003X
- Legal business name
- FAYETTE DOWNTOWN PHARMACY, INC
- Practice address
- 1128 2ND Ave NE
Fayette, AL 35555-1739 - Phone
- (205) 932-4513
- Fax
- (205) 932-9203
- NPI assigned
- Sep 18, 2018
- Organization subpart
- No
Authorized official
- Name
- Katie Wakefield, PHARMD
- Title
- Owner/Pharmacist
- Phone
- (205) 412-7150
Practitioners 1
-
William Trent Mobley, R.PH.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in AL
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20191025000992 | AL | Part B Supplier - Pharmacy | 6103158084 | Practice locations: Fayette, AL |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Community/Retail Pharmacy | 3336C0003X | Yes |
Addresses
Primary practice location
1128 2ND Ave NE
Fayette, AL 35555-1739
Mailing address
PO Box 666
Fayette, AL 35555-0666
Phone (205) 932-4513
Other names
- Fayette Downtown Pharmacy
Other providers in Fayette, AL
- Fayette County Health Dept Pat 1St CM
- Fayette County Health Dept Prev Health Ed
- Fayette County Health Dept Pri Care
- Fayette County Health Dept STD
- Fayette County Health Dept VFC Immun
- Fayette Medical Center
- Fayette Medical Center
- Fayette Medical Center
- Fayette Medical Center
- Fayette Medical Center Ambulance
All providers in Fayette, AL · Community/Retail Pharmacy in Alabama
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 3, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.