Provider Demographics
NPI:1104194752
Name:JASPER, ALEX DAMON SR (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:ALEX
Middle Name:DAMON
Last Name:JASPER
Suffix:SR
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4544 SAINT STEPHENS RD
Mailing Address - Street 2:
Mailing Address - City:PRICHARD
Mailing Address - State:AL
Mailing Address - Zip Code:36613-3509
Mailing Address - Country:US
Mailing Address - Phone:251-330-1631
Mailing Address - Fax:251-330-1637
Practice Address - Street 1:4544 SAINT STEPHENS RD
Practice Address - Street 2:
Practice Address - City:PRICHARD
Practice Address - State:AL
Practice Address - Zip Code:36613-3509
Practice Address - Country:US
Practice Address - Phone:251-330-1631
Practice Address - Fax:251-330-1637
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-11
Last Update Date:2011-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL15696183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist