Healthcare Provider Details

I. General information

NPI: 1528056983
Provider Name (Legal Business Name): ROBERT M KETCHUM R.PH., M.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/10/2005
Last Update Date: 02/18/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2244 VANESSA DR
BIRMINGHAM AL
35242-4430
US

IV. Provider business mailing address

2244 VANESSA DR
BIRMINGHAM AL
35242-4430
US

V. Phone/Fax

Practice location:
  • Phone: 205-991-0462
  • Fax: 205-991-0462
Mailing address:
  • Phone: 205-991-0462
  • Fax: 205-991-0462

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number7815
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number4434
License Number StateSC
# 3
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number33380
License Number StateTN
# 4
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number2987
License Number StateHI
# 5
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number48107
License Number StateTX
# 6
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number10637
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: