Provider Demographics
NPI:1083907489
Name:GERSTMAN, MICKEY WAYNE (RPH)
Entity Type:Individual
Prefix:MR
First Name:MICKEY
Middle Name:WAYNE
Last Name:GERSTMAN
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 1:1261 MILITARY ST S
Mailing Address - Street 2:
Mailing Address - City:HAMILTON
Mailing Address - State:AL
Mailing Address - Zip Code:35570-5004
Mailing Address - Country:US
Mailing Address - Phone:205-921-7465
Mailing Address - Fax:205-921-7896
Practice Address - Street 1:1261 MILITARY ST S
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:AL
Practice Address - Zip Code:35570-5004
Practice Address - Country:US
Practice Address - Phone:205-921-7465
Practice Address - Fax:205-921-7896
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-18
Last Update Date:2011-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL7556183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist