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NPI Code Detail

MEDICARE: JOE M STREET R.PH.

MEDICARE: JOE M STREET R.PH.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1183500000XPharmacist11623AL

General Provider Information

NPI Number : 1639529217
Entity Type Code : Individual
Provider Name (Legal Business Name) : JOE M STREET R.PH.
Provider Business Mailing Address
First Line : 6680 ATLANTA HWY
Second Line :
City : MONTGOMERY
State : AL
Zip : 36117-4240
Country : US
Telephone Number : 334-409-0611
Fax Number :
Provider Business Practice Location Address
First Line : 6680 ATLANTA HWY
Second Line :
City : MONTGOMERY
State : AL
Zip : 36117-4240
Country : US
Telephone Number : 334-409-0611
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/15/2016
Last Update Date : 06/15/2016

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