Healthcare Provider Details

I. General information

NPI: 1104194752
Provider Name (Legal Business Name): ALEX DAMON JASPER SR. PHARM D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/11/2011
Last Update Date: 12/11/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4544 SAINT STEPHENS RD
PRICHARD AL
36613-3509
US

IV. Provider business mailing address

4544 SAINT STEPHENS RD
PRICHARD AL
36613-3509
US

V. Phone/Fax

Practice location:
  • Phone: 251-330-1631
  • Fax: 251-330-1637
Mailing address:
  • Phone: 251-330-1631
  • Fax: 251-330-1637

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number15696
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: