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General NPI Number Information
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NPI Number | 1689717225
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Entity Type | Organization
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Legal Business Name | PONQUINETTE, INC.
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Dates
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Enumeration Date | 02/14/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 880 STE. A MARTIN LUTHER KING JR. AVE.
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City | MOBILE
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State | AL
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Zip | 36603-5904
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Country | US
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Telephone | 251-694-1155
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Fax | 251-694-1152
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Provider Business Mailing Address
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Address Line | 880 STE. A MARTIN LUTHER KING JR. AVE.
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City | MOBILE
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State | AL
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Zip | 36603-5904
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Country | US
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Telephone | 251-694-1155
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Fax | 251-694-1152
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Authorized Official
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Title or Position | PHARMACIST
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Name | LYNNE DAVIS WESTBROOK
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Credential | RPH
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Telephone | 251-694-1155
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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 | 7555
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License Number State | AL
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