=====================================================
General NPI Number Information
=====================================================
NPI Number | 1447246251
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MTM SERVICES OF ALABAMA,INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/27/2005
-----------------------------------------------------
Last Update Date | 11/15/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 409 ST CLAIR AVE
-----------------------------------------------------
City | HUNTSVILLE
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 35801-5120
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 256-518-9530
-----------------------------------------------------
Fax | 256-518-9531
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 409 ST CLAIR AVE
-----------------------------------------------------
City | HUNTSVILLE
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 35801-5120
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 256-518-9530
-----------------------------------------------------
Fax | 256-518-9531
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT/OWNER
-----------------------------------------------------
Name | MS. REBECCA H. STERLING
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 256-518-9530
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 333600000X
-----------------------------------------------------
Taxonomy Name | Pharmacy
-----------------------------------------------------
License Number | 112821
-----------------------------------------------------
License Number State | AL
-----------------------------------------------------