Provider Demographics
NPI:1023001278
Name:GUTHERY, PHILLIP MICHAEL (OD, RPH)
Entity Type:Individual
Prefix:DR
First Name:PHILLIP
Middle Name:MICHAEL
Last Name:GUTHERY
Suffix:
Gender:M
Credentials:OD, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 7TH ST SW STE B
Mailing Address - Street 2:
Mailing Address - City:CULLMAN
Mailing Address - State:AL
Mailing Address - Zip Code:35055-4265
Mailing Address - Country:US
Mailing Address - Phone:256-775-3937
Mailing Address - Fax:256-775-6001
Practice Address - Street 1:100 7TH ST SW STE B
Practice Address - Street 2:
Practice Address - City:CULLMAN
Practice Address - State:AL
Practice Address - Zip Code:35055-4265
Practice Address - Country:US
Practice Address - Phone:256-775-3937
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-23
Last Update Date:2012-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALS791 TA327152W00000X
AL11485183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL000047115Medicaid
ALU52291Medicare UPIN
AL000047115Medicaid
AL000047115Medicare PIN