Provider Demographics
NPI:1962411959
Name:GANN, JIMMY BRUCE VI (RPH)
Entity type:Individual
Prefix:
First Name:JIMMY
Middle Name:BRUCE
Last Name:GANN
Suffix:VI
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 1:444 TURNBERRY LN
Mailing Address - Street 2:
Mailing Address - City:ALBERTVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35951-3968
Mailing Address - Country:US
Mailing Address - Phone:256-659-2117
Mailing Address - Fax:256-659-2117
Practice Address - Street 1:41554 AL HWY 75
Practice Address - Street 2:
Practice Address - City:GERALDINE
Practice Address - State:AL
Practice Address - Zip Code:35974
Practice Address - Country:US
Practice Address - Phone:256-659-2117
Practice Address - Fax:256-659-2117
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL6029183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL0107119OtherNABP