=====================================================
General NPI Number Information
=====================================================
NPI Number | 1023316684
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | BYRON BANKESTER
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/07/2011
-----------------------------------------------------
Last Update Date | 03/07/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1904 HERITAGE LN SW
-----------------------------------------------------
City | HARTSELLE
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 35640-3550
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 256-751-2958
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1904 HERITAGE LN, SW
-----------------------------------------------------
City | HARTSELLE
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 35640
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 8092
-----------------------------------------------------
License Number State | AL
-----------------------------------------------------