Healthcare Provider Details

I. General information

NPI: 1144529280
Provider Name (Legal Business Name): JOHN MORGAN GENTRY RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/15/2011
Last Update Date: 03/15/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

87458 US HIGHWAY 278
ALTOONA AL
35952-9638
US

IV. Provider business mailing address

PO BOX 510
SNEAD AL
35952-0510
US

V. Phone/Fax

Practice location:
  • Phone: 205-466-7990
  • Fax: 205-466-3603
Mailing address:
  • Phone: 205-466-7990
  • Fax: 205-466-3603

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number7897
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: