Healthcare Provider Details

I. General information

NPI: 1083907489
Provider Name (Legal Business Name): MICKEY WAYNE GERSTMAN R.PH.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/18/2011
Last Update Date: 05/18/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1261 MILITARY ST S
HAMILTON AL
35570-5004
US

IV. Provider business mailing address

1261 MILITARY ST S
HAMILTON AL
35570-5004
US

V. Phone/Fax

Practice location:
  • Phone: 205-921-7465
  • Fax: 205-921-7896
Mailing address:
  • Phone: 205-921-7465
  • Fax: 205-921-7896

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number7556
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: