Organization Active NPI

Shoals Family Pharmacy Group Inc

Doing business as Family Pharmacy of Russellville

  • Community/Retail Pharmacy
  • Russellville, AL
National Provider Identifier
1134454150
Registry record updated May 7, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
113307 Issued in AL
Legal business name
SHOALS FAMILY PHARMACY GROUP INC
Doing business as
Family Pharmacy of Russellville
Practice address
455 Underwood Rd
Russellville, AL 35653-4111
Phone
(256) 332-5545
Fax
(256) 332-5582
NPI assigned
Oct 8, 2009
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 7, 2026

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

Authorized official

Name
Jeremy Heath Lane
Title
Pharmacist
Phone
(256) 332-5545

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacy 333600000X
Community/Retail Pharmacy 3336C0003X 113307 AL Primary

Addresses

Primary practice location

455 Underwood Rd
Russellville, AL 35653-4111

Mailing address

455 Underwood Rd
Russellville, AL 35653-4111
Phone (256) 332-5545

Other identifiers 2

IdentifierTypeStateIssuer
114855MedicaidAL
2122269OtherPK

Other names 1

  • Family Pharmacy of Russellville Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20110708000111 AL Part B Supplier - Mass Immunization (Roster Biller Only) 8921286329 1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Russellville, AL

Other NPIs on the same Medicare enrollment 1

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
01D2225417Family Pharmacy of Russellville455 Underwood Road, Russellville, AL 35653Certificate of waiverMay 19, 2027

National Provider Directory

National Provider Directory
Tax ID family
Family Pharmacy of Russellville3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

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

NPI Registry JSON

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

{
    "created_epoch": "1254960000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1778112000000",
    "number": "1134454150",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "455 UNDERWOOD RD",
            "city": "RUSSELLVILLE",
            "state": "AL",
            "postal_code": "356534111",
            "telephone_number": "256-332-5545",
            "fax_number": "256-332-5582"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "455 UNDERWOOD RD",
            "city": "RUSSELLVILLE",
            "state": "AL",
            "postal_code": "356534111",
            "telephone_number": "256-332-5545",
            "fax_number": "256-332-5582"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHOALS FAMILY PHARMACY GROUP INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-10-08",
        "last_updated": "2026-05-07",
        "certification_date": "2026-05-07",
        "status": "A",
        "authorized_official_last_name": "LANE",
        "authorized_official_first_name": "JEREMY",
        "authorized_official_middle_name": "HEATH",
        "authorized_official_title_or_position": "PHARMACIST",
        "authorized_official_telephone_number": "256-332-5545"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "AL",
            "license": "113307",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "114855",
            "state": "AL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2122269",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Family Pharmacy of Russellville",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Russellville, AL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 7, 2026; 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.