MEDICARE: MR. KERRY A PRICKETT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	10727	AL

General Provider Information

NPI Number	:	1376658195
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. KERRY A PRICKETT

Provider Business Mailing Address
First Line	:	740 DONNA DR
Second Line	:
City	:	BIRMINGHAM
State	:	AL
Zip	:	35226-2838
Country	:	US
Telephone Number	:	205-823-5089
Fax Number	:	205-425-1373

Provider Business Practice Location Address
First Line	:	985 9TH AVE SW
Second Line	:
City	:	BESSEMER
State	:	AL
Zip	:	35022-4500
Country	:	US
Telephone Number	:	205-426-3784
Fax Number	:	205-426-3763

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/20/2006
Last Update Date	:	07/08/2007

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Directions to “ MR. KERRY A PRICKETT ” Practice Location

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