Provider Demographics
NPI:1285700716
Name:MIKELL, STALLARD DELMUS JR (RPH)
Entity type:Individual
Prefix:
First Name:STALLARD
Middle Name:DELMUS
Last Name:MIKELL
Suffix:JR
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3920 CHAPMAN RD
Mailing Address - Street 2:
Mailing Address - City:MILLBROOK
Mailing Address - State:AL
Mailing Address - Zip Code:36054-2523
Mailing Address - Country:US
Mailing Address - Phone:334-285-5253
Mailing Address - Fax:334-285-7415
Practice Address - Street 1:3625 HIGHWAY 14
Practice Address - Street 2:
Practice Address - City:MILLBROOK
Practice Address - State:AL
Practice Address - Zip Code:36054-1842
Practice Address - Country:US
Practice Address - Phone:334-285-8335
Practice Address - Fax:334-285-5298
Is Sole Proprietor?:No
Enumeration Date:2006-11-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL7264183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist