Healthcare Provider Details

I. General information

NPI: 1285700716
Provider Name (Legal Business Name): STALLARD DELMUS MIKELL JR. RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/27/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3625 HIGHWAY 14
MILLBROOK AL
36054-1842
US

IV. Provider business mailing address

3920 CHAPMAN RD
MILLBROOK AL
36054-2523
US

V. Phone/Fax

Practice location:
  • Phone: 334-285-8335
  • Fax: 334-285-5298
Mailing address:
  • Phone: 334-285-5253
  • Fax: 334-285-7415

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number7264
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: