NPIMap

Organization Active NPI

Shoals Family Pharmacy Group Inc

  • Community/Retail Pharmacy
  • Russellville, AL
National Provider Identifier
1427384577
Registry record updated Oct 20, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
113306 Issued in AL
Legal business name
SHOALS FAMILY PHARMACY GROUP INC
Doing business as
The Drug Shop of Russellville
Practice address
318 Jackson Ave S
Suite 1
Russellville, AL 35653-2207
Phone
(256) 332-8550
Fax
(256) 332-8081
NPI assigned
Oct 26, 2009
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 20, 2015

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

Authorized official

Name
Jeremy Lane
Title
Owner/Pharmacist
Phone
(256) 810-3331

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Retail Pharmacy 3336C0003X 113306 AL Primary

Addresses

Primary practice location

318 Jackson Ave S
Suite 1
Russellville, AL 35653-2207

Mailing address

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

Other identifiers 1

IdentifierTypeStateIssuer
2122271OtherPK

Other names 1

  • The Drug Shop 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
Practice locations: Russellville, AL

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 1

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

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.

Locations

318 Jackson Ave S
Ste 1
Russellville, AL 35653
Phone (256) 332-8550

NPI Registry JSON

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

{
    "created_epoch": "1256515200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1445299200000",
    "number": "1427384577",
    "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": "318 JACKSON AVE S",
            "address_2": "SUITE 1",
            "city": "RUSSELLVILLE",
            "state": "AL",
            "postal_code": "356532207",
            "telephone_number": "256-332-8550",
            "fax_number": "256-332-8081"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHOALS FAMILY PHARMACY GROUP INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-10-26",
        "last_updated": "2015-10-20",
        "status": "A",
        "authorized_official_last_name": "LANE",
        "authorized_official_first_name": "JEREMY",
        "authorized_official_title_or_position": "OWNER/PHARMACIST",
        "authorized_official_telephone_number": "256-810-3331"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "AL",
            "license": "113306",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2122271",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "The Drug Shop 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 Oct 20, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.