Bayou Pharmacy LLC – Community/Retail Pharmacy

Key facts

NPI: 1629304183
Entity type: Organization (NPI type 2)
Primary specialty: Community/Retail Pharmacy 3336C0003X
License: 113326 (AL)
Legal business name: BAYOU PHARMACY LLC
Practice address: 12855 Padgett Switch Rd
Irvington, AL 36544-4015
Phone: (251) 824-7979
Fax: (251) 824-7989
NPI assigned: Oct 19, 2009
Organization subpart: No

Authorized official

Name: Charles Cottrell
Title: President/Pharmacist
Phone: (251) 824-7979

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

Rubesh Patel, PHARM D Pharmacist · Irvington, AL · NPI 1861089617

NPD (past)

Laboratory certificates & supplier records

Name & address match These CMS records do not include an NPI. They are shown here because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA number	Laboratory	Certificate	Expires
01D2190611	Bayou Pharmacy 12855 Padgett Switch, Irvington, AL 36544	Certificate of waiver	Aug 16, 2026

Medicare participation

Medicare fee-for-service enrollment: Enrolled in AL

Medicare enrollment records

Enrollment ID	State	Provider type	PAC ID	Details
O20181106002708	AL	Part B Supplier - Pharmacy	9537351978	Practice locations: Irvington, AL

National Provider Directory

Locations

13240 N Wintzell Ave
Bayou Labatre, AL 36509
Phone (251) 824-7979

12855 Padgett Switch Rd
Irvington, AL 36544
Phone (251) 824-7979

Specialties & licenses

Specialty (taxonomy)	Code	License	State	Primary
Pharmacy	333600000X
Community/Retail Pharmacy	3336C0003X	113326	AL	Yes

Addresses

Primary practice location

12855 Padgett Switch Rd
Irvington, AL 36544-4015

Mailing address

PO Box 129
Grand Bay, AL 36541-0129
Phone (251) 865-1040

Other identifiers

Identifier	Type	State	Issuer
114666	Medicaid	AL
2122525	Other		PK

Other names

Bayou Pharmacy Doing business as

Other providers in Irvington, AL

All providers in Irvington, 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 Oct 18, 2024. 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.
Medicare Care Compare provider data (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.