Provider Demographics
NPI:1255679221
Name:UPCHURCH, JOSHUA (PHARMD)
Entity Type:Individual
Prefix:
First Name:JOSHUA
Middle Name:
Last Name:UPCHURCH
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:708 JACKSON AVE N
Mailing Address - Street 2:
Mailing Address - City:RUSSELLVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35653-1624
Mailing Address - Country:US
Mailing Address - Phone:256-460-0528
Mailing Address - Fax:
Practice Address - Street 1:322 COX CREEK PKWY
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:AL
Practice Address - Zip Code:35630-1540
Practice Address - Country:US
Practice Address - Phone:256-718-1795
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-24
Last Update Date:2013-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL17062183500000X
TN37153183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist