=====================================================
General NPI Number Information
=====================================================
NPI Number | 1700297629
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LYDIA GRIM RATHER PHARMD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/13/2014
-----------------------------------------------------
Last Update Date | 05/13/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3280 DAUPHIN ST BUILDING C SUITE 115
-----------------------------------------------------
City | MOBILE
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 36606-4060
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 251-476-5656
-----------------------------------------------------
Fax | 251-476-5155
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3280 DAUPHIN ST BUILDING C SUITE 115
-----------------------------------------------------
City | MOBILE
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 36606-4060
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 251-476-5656
-----------------------------------------------------
Fax | 251-476-5155
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 15566
-----------------------------------------------------
License Number State | AL
-----------------------------------------------------