Provider Demographics
NPI:1477820413
Name:HORSLEY, ROY DERIS JR
Entity Type:Individual
Prefix:MR
First Name:ROY
Middle Name:DERIS
Last Name:HORSLEY
Suffix:JR
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 1:107 E MEIGHAN BLVD
Mailing Address - Street 2:
Mailing Address - City:GADSDEN
Mailing Address - State:AL
Mailing Address - Zip Code:35903-1044
Mailing Address - Country:US
Mailing Address - Phone:256-547-4719
Mailing Address - Fax:256-547-9361
Practice Address - Street 1:107 E MEIGHAN BLVD
Practice Address - Street 2:
Practice Address - City:GADSDEN
Practice Address - State:AL
Practice Address - Zip Code:35903-1044
Practice Address - Country:US
Practice Address - Phone:256-547-4719
Practice Address - Fax:256-547-9361
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-18
Last Update Date:2011-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL7180183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist