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General NPI Number Information
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NPI Number | 1790389252
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Entity Type | Individual
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Provider Name | GARY PHILLIP RICH
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Gender | Male
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Dates
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Enumeration Date | 11/25/2020
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Last Update Date | 11/25/2020
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Provider Practice Location Address
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Address Line | 1001 PELHAM RD S
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City | JACKSONVILLE
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State | AL
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Zip | 36265-3021
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Country | US
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Telephone | 256-435-2095
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Fax |
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Provider Business Mailing Address
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Address Line | 13 WINFIELD LN
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City | GADSDEN
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State | AL
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Zip | 35905-8816
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Country | US
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Telephone | 702-461-2356
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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 | 9833
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License Number State | AL
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