Provider Demographics
NPI:1104141274
Name:FAULK, VICKI DORMAN (RPH)
Entity type:Individual
Prefix:
First Name:VICKI
Middle Name:DORMAN
Last Name:FAULK
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:545 COTTON GIN RD
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36117-3552
Mailing Address - Country:US
Mailing Address - Phone:334-396-9466
Mailing Address - Fax:334-396-6759
Practice Address - Street 1:545 COTTON GIN RD
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36117-3552
Practice Address - Country:US
Practice Address - Phone:334-396-9466
Practice Address - Fax:334-396-6759
Is Sole Proprietor?:No
Enumeration Date:2010-04-01
Last Update Date:2010-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL11777183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist