BAYOU PHARMACY (BAYOU PHARMACY LLC) NPI 1629304183

Pharmacy (Community/Retail Pharmacy) in Irvington, AL

NPI 1629304183 Organization Pharmacy Community/Retail Pharmacy CLIA Number 01D2190611 CLIA Certificate of Waiver

About BAYOU PHARMACY (BAYOU PHARMACY LLC)

Bayou Pharmacy (bayou Pharmacy Llc) is a provider established in Irvington, Alabama specializing in pharmacy (community/retail pharmacy) . The NPI number of Bayou Pharmacy (bayou Pharmacy Llc) is 1629304183 and was assigned on October 2009. The practitioner's primary taxonomy code is 3336C0003X with license number 113326 (AL). The provider is registered as an organization and their NPI record was last updated 5 years ago. The provider's is doing business as Bayou Pharmacy. The authorized official of this NPI record is Charles Cottrell (President/pharmacist)

The CLIA number of Bayou Pharmacy is 01D2190611 registered as a "pharmacy" facility with a CLIA Certificate of Waiver. This CLIA certificate is issued to Bayou Pharmacy to perform only waived tests. CLIA defines waived tests as simple tests with a low risk for an incorrect result. Waived tests include certain tests listed in CLIA regulations, tests cleared by the FDA for home use and tests approved by the FDA for waived status and that meet CLIA waiver criteria.

NPI

1629304183

Provider NameBAYOU PHARMACY (BAYOU PHARMACY LLC)
Provider Location Address12855 PADGETT SWITCH RD IRVINGTON, AL 36544
Provider Mailing Address12855 PADGETT SWITCH RD IRVINGTON, AL 36544
NPI Entity TypeOrganization
Is Sole Proprietor?N/A
Is Organization Subpart?No
Other Organization NameBAYOU PHARMACY
Other Name TypeDoing Business As (3)
Enumeration Date10-19-2009
Last Update Date03-16-2017


Primary Taxonomy

Taxonomy Code3336C0003X
ClassificationPharmacy
TypeSuppliers
SpecializationCommunity/Retail Pharmacy
License No.113326
License StateAL
Taxonomy DescriptionA pharmacy where pharmacists store, prepare, and dispense medicinal preparations and/or prescriptions for a local patient population in accordance with federal and state law; counsel patients and caregivers (sometimes independent of the dispensing process); administer vaccinations; and provide other professional services associated with pharmaceutical care such as health screenings, consultative services with other health care providers, collaborative practice, disease state management, and education classes.

Business Address

BAYOU PHARMACY
12855 PADGETT SWITCH RD
IRVINGTON, AL
ZIP 36544
Phone: (251) 824-7979
Fax: (251) 824-7989

Get Directions


Mailing Address

BAYOU PHARMACY
12855 PADGETT SWITCH RD
IRVINGTON, AL
ZIP 36544
Phone: (251) 824-7979
Fax: (251) 824-7989



Authorized Official

Authorized Official Name CHARLES COTTRELL
Authorized Official TitlePRESIDENT/PHARMACIST
Authorized Official Phone(251) 824-7979

CLIA Information

The Clinical Laboratory Improvement Amendments (CLIA) of 1988 applies to facilities or sites that test human specimens for health assessment or to diagnose, prevent, or treat disease. The CLIA Program sets standards for clinical laboratory testing and issues certificates. The NPI / CLIA crosswalk information for the NPI number 1629304183 is:

CLIA Number01D2190611
Facility TypePHARMACY
Certificate TypeCertificate of Waiver

Secondary Taxonomies


The secondary taxonomy codes define the provider type, classification, and specialization. For individual NPIs the license data is associated to each taxonomy code.

No. Taxonomy Code Type Classification Specialization License No. State Primary
1333600000XSuppliersPharmacyNo

Taxonomy Description: a facility used by pharmacists for the compounding and dispensing of medicinal preparations and other associated professional and administrative services. A pharmacy is a facility whose primary function is to store, prepare and legally dispense prescription drugs under the professional supervision of a licensed pharmacist. It meets any licensing or certification standards set forth by the jurisdiction where it is located.

Additional Identifiers


Additional identifier(s) currently or formerly used as an identifier for the provider. The codes may include UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers.

Identifier Type / Code Identifier State
114666MEDICAID (05)AL
6443060001MEDICARE NSC (07)
2122525OTHER (01)

Other Providers at the same location


The following provider is registered at the same or nearby location.

NPI Name / Type Taxonomy Address
1861089617DR. RUBESH PATEL PHARM D
Individual
Pharmacist12855 PADGETT SWITCH RD
IRVINGTON, AL 36544
(251) 824-7979

NPI Footnotes

What is the National Provider Indentifier (NPI)?
The NPI is 10-position all-numeric identification number assigned by the NPPES to uniquely identify a health care provider.

Provider Location Address
The location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.

Provider Mailing Address
The mailing address of the provider being identified. This address may contain the same information as the provider location address.

Entity Type Code
The code describing the type of health care provider that is being assigned an NPI.
The entity type codes are:
1 = Person: individual human being who furnishes health care;
2 = Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)

What is a Subpart?
Subparts are the components and separate physical locations of organization health care providers. Subpart examples include:
Hospital components include outpatient departments, surgical centers, psychiatric units, and laboratories. These components are often separately licensed or certified by States and may exist at physical locations other than that of the hospital of which they are a component.

Provider Other Organization Name
The other organization name is the alternative last name by which the provider is or has been known (if an individual) or other name by which the organization provider is or has been known. The code identifying the type of other name. The provider other organization name codes are:
1 = former name;
2 = professional name;
3 = doing business as (d/b/ a) name;
4 = former legal business name; :
5 = other.

Provider Enumeration Date
The date the provider was assigned a unique identifier (assigned an NPI).

Last Update Date
The date that a NPI record was last updated or changed.

Primary Taxonomy Code
The primary taxonomy code defines the provider type, classification, and specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.

Authorized Official Name
The name of the person authorized to submit the NPI application or to officially change data for a health care provider.