MEDICARE: MR. STEPHEN E POOLE

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	E09916	MS
2	183500000X	Pharmacist	15056	AL

General Provider Information

NPI Number	:	1982989877
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. STEPHEN E POOLE

Provider Business Mailing Address
First Line	:	2355 RIDGEMONT DR
Second Line	:
City	:	HOOVER
State	:	AL
Zip	:	35244-1206
Country	:	US
Telephone Number	:	205-470-3711
Fax Number	:

Provider Business Practice Location Address
First Line	:	2461 5TH ST N
Second Line	:
City	:	COLUMBUS
State	:	MS
Zip	:	39705-2005
Country	:	US
Telephone Number	:	662-327-0079
Fax Number	:

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

Provider Enumeration Date	:	10/11/2011
Last Update Date	:	10/11/2011

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Directions to “ MR. STEPHEN E POOLE ” Practice Location

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