Healthcare Provider Details

I. General information

NPI: 1427688753
Provider Name (Legal Business Name): ROWDY MATT MEADOWS PHARMACIST
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/26/2020
Last Update Date: 01/26/2020
Certification Date: 01/26/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 S GILMER AVE
LANETT AL
36863-2942
US

IV. Provider business mailing address

1401 S GILMER AVE
LANETT AL
36863-2942
US

V. Phone/Fax

Practice location:
  • Phone: 334-642-6888
  • Fax: 334-642-6890
Mailing address:
  • Phone: 334-642-6888
  • Fax: 334-642-6890

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number12766
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: