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General NPI Number Information
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NPI Number | 1093210544
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Entity Type | Individual
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Provider Name | JEFFREY MATHIS PHARMACIST
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Gender | Male
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Dates
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Enumeration Date | 03/27/2018
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Last Update Date | 03/27/2018
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Provider Practice Location Address
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Address Line | 425 5TH AVE NW
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City | ATTALLA
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State | AL
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Zip | 35954-2214
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Country | US
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Telephone | 245-413-4455
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Fax |
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Provider Business Mailing Address
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Address Line | 3257 MONTE DORO DR
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City | VESTAVIA HILLS
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State | AL
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Zip | 35216-4621
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 9971
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License Number State | AL
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