Healthcare Provider Details

I. General information

NPI: 1821487810
Provider Name (Legal Business Name): MARK ANTHONY LUMPKIN RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/14/2015
Last Update Date: 08/07/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5560 MCCLELLAN BLVD
ANNISTON AL
36206-1664
US

IV. Provider business mailing address

1625 PELHAM RD S
JACKSONVILLE AL
36265-3314
US

V. Phone/Fax

Practice location:
  • Phone: 256-820-0994
  • Fax: 256-820-8793
Mailing address:
  • Phone: 256-435-1071
  • Fax: 256-435-5934

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number11368
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: