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General NPI Number Information
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NPI Number | 1366706186
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Entity Type | Individual
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Provider Name | THOMAS KELTON BULLOCK JR. RPH
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Gender | Male
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Dates
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Enumeration Date | 06/26/2012
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Last Update Date | 01/17/2024
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Provider Practice Location Address
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Address Line | 703 N MCKENZIE ST
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City | FOLEY
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State | AL
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Zip | 36535-3542
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Country | US
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Telephone | 251-200-5750
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Fax | 251-200-5725
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Provider Business Mailing Address
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Address Line | 10097 GROVE DR
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City | FAIRHOPE
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State | AL
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Zip | 36532-5777
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Country | US
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Telephone | 228-216-2501
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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 | D07327
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License Number State | MS
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Taxonomy #2
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 17582
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License Number State | AL
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