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General NPI Number Information
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NPI Number | 1942585187
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Entity Type | Individual
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Provider Name | MEDFORD LAMAR HASKEW R.PH.
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Gender | Male
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Dates
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Enumeration Date | 10/19/2011
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Last Update Date | 10/19/2011
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Provider Practice Location Address
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Address Line | 900 RUCKER BLVD
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City | ENTERPRISE
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State | AL
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Zip | 36330-2160
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Country | US
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Telephone | 334-393-1348
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Fax |
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Provider Business Mailing Address
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Address Line | 13612 PINE FOREST RD
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City | ANDALUSIA
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State | AL
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Zip | 36420-9263
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Country | US
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Telephone | 334-764-2196
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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 | 9211
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License Number State | AL
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