Provider Demographics
NPI:1962530279
Name:GARDNER, JAMES ALAN (RPH)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:ALAN
Last Name:GARDNER
Suffix:
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 1:15192 AL HIGHWAY 68
Mailing Address - Street 2:BOX 37
Mailing Address - City:CROSSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35962-3452
Mailing Address - Country:US
Mailing Address - Phone:256-528-7124
Mailing Address - Fax:
Practice Address - Street 1:15192 AL HIGHWAY 68
Practice Address - Street 2:BOX 37
Practice Address - City:CROSSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35962-3452
Practice Address - Country:US
Practice Address - Phone:256-528-7124
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL12053183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL0105773Medicare UPIN