Provider Demographics
NPI:1821487810
Name:LUMPKIN, MARK ANTHONY (RPH)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:ANTHONY
Last Name:LUMPKIN
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 1:1625 PELHAM RD S
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:36265-3314
Mailing Address - Country:US
Mailing Address - Phone:256-435-1071
Mailing Address - Fax:256-435-5934
Practice Address - Street 1:5560 MCCLELLAN BLVD
Practice Address - Street 2:
Practice Address - City:ANNISTON
Practice Address - State:AL
Practice Address - Zip Code:36206-1664
Practice Address - Country:US
Practice Address - Phone:256-820-0994
Practice Address - Fax:256-820-8793
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-14
Last Update Date:2016-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL11368183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALAL 11368OtherALABAMA PHARMACY LICENSE