Healthcare Provider Details

I. General information

NPI: 1265051635
Provider Name (Legal Business Name): SHAYNE KREUTZER PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/15/2020
Last Update Date: 04/15/2020
Certification Date: 04/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4145 CARMICHAEL RD
MONTGOMERY AL
36106-2803
US

IV. Provider business mailing address

222 DOE RUN CT
PIKE ROAD AL
36064-4500
US

V. Phone/Fax

Practice location:
  • Phone: 334-273-7000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number20323
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: