Provider Demographics
NPI:1669473534
Name:KESSLER, MIKE (RPH)
Entity Type:Individual
Prefix:MR
First Name:MIKE
Middle Name:
Last Name:KESSLER
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 1:507 N COLUMBIA AVE
Mailing Address - Street 2:
Mailing Address - City:SHEFFIELD
Mailing Address - State:AL
Mailing Address - Zip Code:35660-2935
Mailing Address - Country:US
Mailing Address - Phone:256-381-4311
Mailing Address - Fax:256-386-0903
Practice Address - Street 1:507 N COLUMBIA AVE
Practice Address - Street 2:
Practice Address - City:SHEFFIELD
Practice Address - State:AL
Practice Address - Zip Code:35660-2935
Practice Address - Country:US
Practice Address - Phone:256-381-4311
Practice Address - Fax:256-386-0903
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-02
Last Update Date:2013-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL9262183500000X
AL1067013336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL142329Medicaid
0103298OtherNCPDP
AL000052218Medicaid
AL142329Medicaid