Provider Demographics
NPI:1831292903
Name:WRIGHT, LON EDWARD (RPH PD)
Entity Type:Individual
Prefix:MR
First Name:LON
Middle Name:EDWARD
Last Name:WRIGHT
Suffix:
Gender:M
Credentials:RPH PD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 408
Mailing Address - Street 2:13532 HWY 96 E
Mailing Address - City:MILLPORT
Mailing Address - State:AL
Mailing Address - Zip Code:35576
Mailing Address - Country:US
Mailing Address - Phone:205-662-3817
Mailing Address - Fax:205-662-5786
Practice Address - Street 1:13532 HWY 96 E
Practice Address - Street 2:
Practice Address - City:MILLPORT
Practice Address - State:AL
Practice Address - Zip Code:35576
Practice Address - Country:US
Practice Address - Phone:205-662-3817
Practice Address - Fax:205-662-5786
Is Sole Proprietor?:No
Enumeration Date:2006-09-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL7060183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL1000001410Medicaid
AL1000001410Medicaid