=====================================================
General NPI Number Information
=====================================================
NPI Number | 1386941342
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | THOMAS PRESLEY MYERS JR. RPH
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/26/2011
-----------------------------------------------------
Last Update Date | 02/26/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4200 MCFARLAND BLVD E
-----------------------------------------------------
City | TUSCALOOSA
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 35405-3853
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 205-759-1103
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4207 4TH AVE E
-----------------------------------------------------
City | NORTHPORT
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 35473-5117
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 205-759-4992
-----------------------------------------------------
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 | 7472
-----------------------------------------------------
License Number State | AL
-----------------------------------------------------