Healthcare Provider Details

I. General information

NPI: 1821600115
Provider Name (Legal Business Name): JAMES EASON MADDOX RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/19/2020
Last Update Date: 08/19/2020
Certification Date: 08/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1380 HIGHLAND ST
MONTEVALLO AL
35115-3570
US

IV. Provider business mailing address

1380 HIGHLAND ST
MONTEVALLO AL
35115-3570
US

V. Phone/Fax

Practice location:
  • Phone: 205-222-2921
  • Fax: 334-366-2425
Mailing address:
  • Phone: 205-222-2921
  • Fax: 334-366-2425

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number7731
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: