Provider Demographics
NPI:1497283592
Name:HARGRAVE, ALFRED EARL (RPH)
Entity Type:Individual
Prefix:
First Name:ALFRED
Middle Name:EARL
Last Name:HARGRAVE
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 1:7108 PINECREST DR
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36117-7412
Mailing Address - Country:US
Mailing Address - Phone:334-467-8595
Mailing Address - Fax:
Practice Address - Street 1:10710 CHANTILLY PKWY
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36117-7587
Practice Address - Country:US
Practice Address - Phone:334-272-7114
Practice Address - Fax:334-272-7305
Is Sole Proprietor?:No
Enumeration Date:2017-06-01
Last Update Date:2017-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL14069183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist