MEDICARE: DR. JERMAINE GERARD TILLER PHARMD

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	15106	AL

General Provider Information

NPI Number	:	1972562197
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JERMAINE GERARD TILLER PHARMD

Provider Business Mailing Address
First Line	:	12390 CAMBRON TRL
Second Line	:
City	:	SPANISH FORT
State	:	AL
Zip	:	36527-8744
Country	:	US
Telephone Number	:	504-722-4522
Fax Number	:

Provider Business Practice Location Address
First Line	:	3150 BEL AIR MALL
Second Line	:
City	:	MOBILE
State	:	AL
Zip	:	36606-3206
Country	:	US
Telephone Number	:	251-471-9768
Fax Number	:

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

Provider Enumeration Date	:	03/18/2006
Last Update Date	:	06/30/2011

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