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General NPI Number Information
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NPI Number | 1952526600
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Entity Type | Individual
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Provider Name | BOBBY DONALD MAISE RPH
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Gender | Male
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Dates
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Enumeration Date | 04/16/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1152 EAST LAKE BLVD
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City | TARRANT
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State | AL
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Zip | 35217
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Country | US
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Telephone | 205-841-6421
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Fax | 205-841-2405
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Provider Business Mailing Address
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Address Line | 821 CROSSHILL LANE
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City | WARRIOR
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State | AL
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Zip | 35180-5540
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Country | US
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Telephone | 205-647-6635
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Fax | 205-841-2405
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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 | 6060
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License Number State | AL
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Taxonomy #2
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 10548
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License Number State | FL
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