Healthcare Provider Details

I. General information

NPI: 1003025339
Provider Name (Legal Business Name): JAMES D WURST PHARM.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/22/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1725 PINE ST
MONTGOMERY AL
36106-1109
US

IV. Provider business mailing address

707 FOUNTAIN LN
PRATTVILLE AL
36067-2860
US

V. Phone/Fax

Practice location:
  • Phone: 334-293-8696
  • Fax:
Mailing address:
  • Phone: 334-358-4990
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number14239
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: