Provider Demographics
NPI:1659975720
Name:BABB, MARK DENNIS
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:DENNIS
Last Name:BABB
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 1:536 HUDSON DR
Mailing Address - Street 2:
Mailing Address - City:GORDO
Mailing Address - State:AL
Mailing Address - Zip Code:35466-2431
Mailing Address - Country:US
Mailing Address - Phone:205-364-7133
Mailing Address - Fax:
Practice Address - Street 1:536 HUDSON DR
Practice Address - Street 2:
Practice Address - City:GORDO
Practice Address - State:AL
Practice Address - Zip Code:35466-2431
Practice Address - Country:US
Practice Address - Phone:205-364-7133
Practice Address - Fax:205-364-6123
Is Sole Proprietor?:No
Enumeration Date:2020-11-29
Last Update Date:2020-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL11129183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist