New Grand Bay Pharmacy, LLC

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

113415 Issued in AL

Legal business name

NEW GRAND BAY PHARMACY, LLC

Practice address

10067 Grand Bay Wilmer Rd S
Grand Bay, AL 36541-5003

Phone

(251) 865-5555

Fax

(251) 865-3785

NPI assigned

Jul 28, 2010

Organization subpart

No

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

Authorized official

Name

Mr. Charles D Cottrell, RPH

Title

President

Phone

(251) 865-5555

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Grand Bay Pharmacy Doing business as

Medicare fee-for-service enrollment

Enrolled in AL

Enrollment records 1

Locations

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

{
    "created_epoch": "1280275200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1729209600000",
    "number": "1467766865",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 129",
            "city": "GRAND BAY",
            "state": "AL",
            "postal_code": "365410129",
            "telephone_number": "251-865-1040",
            "fax_number": "251-865-1041"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10067 GRAND BAY WILMER RD S",
            "city": "GRAND BAY",
            "state": "AL",
            "postal_code": "365415003",
            "telephone_number": "251-865-5555",
            "fax_number": "251-865-3785"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NEW GRAND BAY PHARMACY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-07-28",
        "last_updated": "2024-10-18",
        "certification_date": "2024-10-18",
        "status": "A",
        "authorized_official_last_name": "COTTRELL",
        "authorized_official_first_name": "CHARLES",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "251-865-5555",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "RPH"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "AL",
            "license": "113415",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "121508",
            "state": "AL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Grand Bay Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Grand Bay Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Community/Retail Pharmacy in Grand Bay, AL
• Providers in Grand Bay, AL by specialty
• Community/Retail Pharmacy in Alabama

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 18, 2024; 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.