Provider Demographics
NPI:1871622555
Name:CITRONELLE DRUG CO INC
Entity type:Organization
Organization Name:CITRONELLE DRUG CO INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OWNER PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:JEFFUS
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:251-866-5522
Mailing Address - Street 1:PO BOX 386
Mailing Address - Street 2:
Mailing Address - City:CITRONELLE
Mailing Address - State:AL
Mailing Address - Zip Code:36522-0386
Mailing Address - Country:US
Mailing Address - Phone:251-866-5522
Mailing Address - Fax:251-866-2335
Practice Address - Street 1:19240 MOBILE ST
Practice Address - Street 2:
Practice Address - City:CITRONELLE
Practice Address - State:AL
Practice Address - Zip Code:36522
Practice Address - Country:US
Practice Address - Phone:251-866-5522
Practice Address - Fax:251-866-2335
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-05
Last Update Date:2010-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL10811183500000X
332B00000X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL100000334Medicaid
AL100000334Medicaid