Provider Demographics
NPI:1346414489
Name:INGRAM, DARREN WAYNE (RPH)
Entity Type:Individual
Prefix:MR
First Name:DARREN
Middle Name:WAYNE
Last Name:INGRAM
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4689 CENTER POINT RD
Mailing Address - Street 2:
Mailing Address - City:PINSON
Mailing Address - State:AL
Mailing Address - Zip Code:35126-4207
Mailing Address - Country:US
Mailing Address - Phone:205-680-2751
Mailing Address - Fax:205-680-6751
Practice Address - Street 1:4689 CENTER POINT RD
Practice Address - Street 2:
Practice Address - City:PINSON
Practice Address - State:AL
Practice Address - Zip Code:35126-4207
Practice Address - Country:US
Practice Address - Phone:205-680-2751
Practice Address - Fax:205-680-6751
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-18
Last Update Date:2008-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL7786183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL7786OtherPHARMACY LICENSE