Provider Demographics
NPI:1487240230
Name:GANN, JIM B JR (RPH)
Entity type:Individual
Prefix:MR
First Name:JIM
Middle Name:B
Last Name:GANN
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:PO BOX 28
Mailing Address - Street 2:
Mailing Address - City:DOUGLAS
Mailing Address - State:AL
Mailing Address - Zip Code:35964-0028
Mailing Address - Country:US
Mailing Address - Phone:256-593-1750
Mailing Address - Fax:256-593-1711
Practice Address - Street 1:9461 AL HIGHWAY 75
Practice Address - Street 2:
Practice Address - City:HORTON
Practice Address - State:AL
Practice Address - Zip Code:35980-8399
Practice Address - Country:US
Practice Address - Phone:256-593-1750
Practice Address - Fax:256-593-1711
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-16
Last Update Date:2020-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL11616183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist