Provider Demographics
NPI:1134332000
Name:PRITCHETT, JEAN JOCSON
Entity Type:Individual
Prefix:
First Name:JEAN
Middle Name:JOCSON
Last Name:PRITCHETT
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 1:3481 ANNETTE ST
Mailing Address - Street 2:
Mailing Address - City:TRUSSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35173-1905
Mailing Address - Country:US
Mailing Address - Phone:205-655-5503
Mailing Address - Fax:
Practice Address - Street 1:3965 CROSSHAVEN DR
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35243-5417
Practice Address - Country:US
Practice Address - Phone:205-969-0767
Practice Address - Fax:205-970-8510
Is Sole Proprietor?:No
Enumeration Date:2007-05-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL15150183500000X
MSE-09563183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist