Provider Demographics
NPI:1700230208
Name:HORNE, DERYL T (RPH)
Entity Type:Individual
Prefix:MRS
First Name:DERYL
Middle Name:T
Last Name:HORNE
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:285 COUNTY ROAD 43 S
Mailing Address - Street 2:
Mailing Address - City:OPELIKA
Mailing Address - State:AL
Mailing Address - Zip Code:36804-1612
Mailing Address - Country:US
Mailing Address - Phone:334-727-2757
Mailing Address - Fax:847-396-2939
Practice Address - Street 1:285 COUNTY ROAD 43 S
Practice Address - Street 2:
Practice Address - City:OPELIKA
Practice Address - State:AL
Practice Address - Zip Code:36804-1612
Practice Address - Country:US
Practice Address - Phone:334-727-2757
Practice Address - Fax:847-396-2933
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-20
Last Update Date:2016-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL7753183500000X
GARPH018184183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist