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General NPI Number Information
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NPI Number | 1720955180
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Entity Type | Individual
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Provider Name | JONATHAN TYLER PROCTOR PHARMD
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Gender | Male
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Dates
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Enumeration Date | 10/21/2025
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Last Update Date | 10/21/2025
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Provider Practice Location Address
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Address Line | 4650 W MAIN ST
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City | DOTHAN
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State | AL
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Zip | 36305-9419
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Country | US
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Telephone | 334-792-6824
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Fax | 334-824-6988
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Provider Business Mailing Address
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Address Line | 5369 10TH ST
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City | MALONE
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State | FL
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Zip | 32445-3428
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Country | US
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Telephone | 334-790-2440
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 24347
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License Number State | AL
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