=====================================================
General NPI Number Information
=====================================================
NPI Number | 1659335149
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | BOYD KENWAY COUGLE JR. PHARMD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/13/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3633 GRAY AVE
-----------------------------------------------------
City | ADAMSVILLE
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 35005-2238
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 205-674-1400
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2348 GARLAND DR
-----------------------------------------------------
City | BIRMINGHAM
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 35216-3020
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 205-979-3321
-----------------------------------------------------
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 | 14802
-----------------------------------------------------
License Number State | AL
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | E09794
-----------------------------------------------------
License Number State | MS
-----------------------------------------------------