Provider Demographics
NPI:1235634338
Name:HADDER, JAMES TRAVIS (PHARM D)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:TRAVIS
Last Name:HADDER
Suffix:
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 1:9052 INDEPENDENCE AVE
Mailing Address - Street 2:
Mailing Address - City:DAPHNE
Mailing Address - State:AL
Mailing Address - Zip Code:36526-5613
Mailing Address - Country:US
Mailing Address - Phone:251-625-6100
Mailing Address - Fax:
Practice Address - Street 1:9052 INDEPENDENCE AVE
Practice Address - Street 2:
Practice Address - City:DAPHNE
Practice Address - State:AL
Practice Address - Zip Code:36526-5613
Practice Address - Country:US
Practice Address - Phone:251-625-6100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-29
Last Update Date:2018-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL15436183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist