Provider Demographics
NPI:1114319944
Name:DEERING, GINA
Entity Type:Individual
Prefix:
First Name:GINA
Middle Name:
Last Name:DEERING
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5651 MOFFETT RD
Mailing Address - Street 2:SUITE C
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36618
Mailing Address - Country:US
Mailing Address - Phone:251-461-9909
Mailing Address - Fax:251-461-9982
Practice Address - Street 1:5651 MOFFETT RD
Practice Address - Street 2:SUITE C
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36618
Practice Address - Country:US
Practice Address - Phone:251-461-9909
Practice Address - Fax:251-461-9982
Is Sole Proprietor?:No
Enumeration Date:2015-03-03
Last Update Date:2015-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL17902183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL09505712Medicaid