Healthcare Provider Details

I. General information

NPI: 1265036420
Provider Name (Legal Business Name): JESSICA DYSON PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/27/2020
Last Update Date: 11/27/2020
Certification Date: 11/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 MAIN ST
MONTEVALLO AL
35115-3713
US

IV. Provider business mailing address

700 MAIN ST
MONTEVALLO AL
35115-3713
US

V. Phone/Fax

Practice location:
  • Phone: 205-665-1004
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number15308
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: