Provider Demographics
NPI:1477193241
Name:GAYHEART, MARK EDWARD (RPH)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:EDWARD
Last Name:GAYHEART
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 1:1061 HIGHWAY 280
Mailing Address - Street 2:
Mailing Address - City:ALEXANDER CITY
Mailing Address - State:AL
Mailing Address - Zip Code:35010-4622
Mailing Address - Country:US
Mailing Address - Phone:256-234-5156
Mailing Address - Fax:256-234-5428
Practice Address - Street 1:1061 HIGHWAY 280
Practice Address - Street 2:
Practice Address - City:ALEXANDER CITY
Practice Address - State:AL
Practice Address - Zip Code:35010-4622
Practice Address - Country:US
Practice Address - Phone:256-234-5156
Practice Address - Fax:256-243-5428
Is Sole Proprietor?:No
Enumeration Date:2020-01-09
Last Update Date:2020-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL20774183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL20774OtherPHARMACIST LICENCE NUMBER