Healthcare Provider Details

I. General information

NPI: 1558403097
Provider Name (Legal Business Name): MR. GEORGE STEPHEN WHEELER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/13/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1709 VETERANS MEMORIAL PKWY
LANETT AL
36863-4709
US

IV. Provider business mailing address

528 BELMONTE DR
AUBURN AL
36830-1286
US

V. Phone/Fax

Practice location:
  • Phone: 334-576-2418
  • Fax: 334-576-0736
Mailing address:
  • Phone: 334-887-5582
  • Fax: 334-576-0736

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number7397
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: