Provider Demographics
NPI:1639507239
Name:SMALL, ALAN (RPH)
Entity Type:Individual
Prefix:MR
First Name:ALAN
Middle Name:
Last Name:SMALL
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 1:1121 S STATE ST
Mailing Address - Street 2:
Mailing Address - City:HEMET
Mailing Address - State:CA
Mailing Address - Zip Code:92543-7635
Mailing Address - Country:US
Mailing Address - Phone:951-652-5988
Mailing Address - Fax:951-765-9118
Practice Address - Street 1:1121 S STATE ST
Practice Address - Street 2:
Practice Address - City:HEMET
Practice Address - State:CA
Practice Address - Zip Code:92543-7635
Practice Address - Country:US
Practice Address - Phone:951-652-5988
Practice Address - Fax:951-765-9118
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-17
Last Update Date:2013-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA45083183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist