Provider Demographics
NPI:1316016124
Name:ST JOHN, JUDY ROWE (RPH)
Entity Type:Individual
Prefix:
First Name:JUDY
Middle Name:ROWE
Last Name:ST JOHN
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21075 RABREN RD
Mailing Address - Street 2:
Mailing Address - City:ANDALUSIA
Mailing Address - State:AL
Mailing Address - Zip Code:36421-8115
Mailing Address - Country:US
Mailing Address - Phone:334-222-9646
Mailing Address - Fax:334-222-9646
Practice Address - Street 1:837 S THREE NOTCH ST
Practice Address - Street 2:
Practice Address - City:ANDALUSIA
Practice Address - State:AL
Practice Address - Zip Code:36420-5321
Practice Address - Country:US
Practice Address - Phone:334-222-1141
Practice Address - Fax:334-222-8361
Is Sole Proprietor?:No
Enumeration Date:2006-11-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL7930183500000X
GAPS011862183500000X
FLPS20113183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL7930OtherPHARMACIST LICENSE
FLPS20113OtherPHARMACIST LICENSE
GAPS011862OtherPHARMACIST LICENSE