Provider Demographics
NPI:1417543265
Name:MONCRIEF, MAXON PAUL
Entity Type:Individual
Prefix:
First Name:MAXON
Middle Name:PAUL
Last Name:MONCRIEF
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1108 13TH ST
Mailing Address - Street 2:
Mailing Address - City:PHENIX CITY
Mailing Address - State:AL
Mailing Address - Zip Code:36867-4966
Mailing Address - Country:US
Mailing Address - Phone:334-298-8390
Mailing Address - Fax:334-298-9870
Practice Address - Street 1:1108 13TH ST
Practice Address - Street 2:
Practice Address - City:PHENIX CITY
Practice Address - State:AL
Practice Address - Zip Code:36867-4966
Practice Address - Country:US
Practice Address - Phone:334-298-8390
Practice Address - Fax:334-298-9870
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-16
Last Update Date:2020-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL13658183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist