Lineville Clinic Pharmacy LLC
Organization Active NPI Community/Retail Pharmacy · Roanoke, AL
NPI 1194730705 · NPPES record last updated Jul 19, 2013
Key facts
- NPI
- 1194730705
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Community/Retail Pharmacy 3336C0003X
- License
- 114138 (AL)
- Legal business name
- LINEVILLE CLINIC PHARMACY LLC
- Practice address
- 3705 Highway 431 Ste B
Roanoke, AL 36274-1430 - Phone
- (334) 863-6337
- Fax
- (334) 863-6339
- NPI assigned
- Jul 30, 2006
- Organization subpart
- No
Authorized official
- Name
- Mark Lowry, PHRM
- Title
- Owner
- Phone
- (334) 863-6337
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in AL
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20210222001197 | AL | Part B Supplier - Mass Immunization (Roster Biller Only) | 8325452311 | Practice locations: Roanoke, AL |
National Provider Directory
Locations
3705 Highway 431
Ste B
Roanoke, AL 36274
Phone (334) 863-6337
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacy | 333600000X | |||
| Clinic Pharmacy | 3336C0002X | |||
| Community/Retail Pharmacy | 3336C0003X | 114138 | AL | Yes |
Addresses
Primary practice location
3705 Highway 431 Ste B
Roanoke, AL 36274-1430
Mailing address
PO Box 248
Roanoke, AL 36274-0248
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1988811 | Other | PK | |
| 100003783 | Medicaid | AL |
Other names
- LOWRY DRUGS AND GIFTS
Other providers in Roanoke, AL
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- Brianna Cofield Jones
- Alisha Pike Kirby
- Matthew W Krason
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- Chrystal D McDaniel
- Megan Elizabeth Wallace McDaniel
- Amy Merrill
- Kittie Messer
- Mitchell C. Shirah M.D. P.C.
All providers in Roanoke, 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 Jul 19, 2013. 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.