Provider Demographics
NPI:1558884569
Name:JARRELL, ROGER EUGENE
Entity Type:Individual
Prefix:
First Name:ROGER
Middle Name:EUGENE
Last Name:JARRELL
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 1:1925 HICKORY HILLS RD
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:AL
Mailing Address - Zip Code:35630-2626
Mailing Address - Country:US
Mailing Address - Phone:256-285-8035
Mailing Address - Fax:
Practice Address - Street 1:517 W. AVALON AVE
Practice Address - Street 2:WALMART PHARMACY
Practice Address - City:MUSCLE SHOALS
Practice Address - State:AL
Practice Address - Zip Code:35661
Practice Address - Country:US
Practice Address - Phone:256-386-7384
Practice Address - Fax:256-386-7386
Is Sole Proprietor?:No
Enumeration Date:2017-07-21
Last Update Date:2017-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL7845183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL7845OtherALABAMA BOARD OF PHARMACY