=====================================================
General NPI Number Information
=====================================================
NPI Number | 1669473534
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MIKE KESSLER RPH
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/02/2005
-----------------------------------------------------
Last Update Date | 07/31/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 507 N COLUMBIA AVE
-----------------------------------------------------
City | SHEFFIELD
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 35660-2935
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 256-381-4311
-----------------------------------------------------
Fax | 256-386-0903
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 507 N COLUMBIA AVE
-----------------------------------------------------
City | SHEFFIELD
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 35660-2935
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 256-381-4311
-----------------------------------------------------
Fax | 256-386-0903
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 9262
-----------------------------------------------------
License Number State | AL
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number | 106701
-----------------------------------------------------
License Number State | AL
-----------------------------------------------------