Provider Demographics
NPI:1821600115
Name:MADDOX, JAMES EASON (RPH)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:EASON
Last Name:MADDOX
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 1:1380 HIGHLAND ST
Mailing Address - Street 2:
Mailing Address - City:MONTEVALLO
Mailing Address - State:AL
Mailing Address - Zip Code:35115-3570
Mailing Address - Country:US
Mailing Address - Phone:205-222-2921
Mailing Address - Fax:334-366-2425
Practice Address - Street 1:1380 HIGHLAND ST
Practice Address - Street 2:
Practice Address - City:MONTEVALLO
Practice Address - State:AL
Practice Address - Zip Code:35115-3570
Practice Address - Country:US
Practice Address - Phone:205-222-2921
Practice Address - Fax:334-366-2425
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-19
Last Update Date:2020-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL7731183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL7731OtherBOARD OF PHARMACY