Provider Demographics
NPI:1851479109
Name:OWENS, SALLY JANE
Entity Type:Individual
Prefix:
First Name:SALLY
Middle Name:JANE
Last Name:OWENS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5350 ATLANTA HWY # C
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36109-3324
Mailing Address - Country:US
Mailing Address - Phone:334-782-0278
Mailing Address - Fax:334-279-7418
Practice Address - Street 1:5350 ATLANTA HWY # C
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36109-3324
Practice Address - Country:US
Practice Address - Phone:334-782-0278
Practice Address - Fax:334-279-7418
Is Sole Proprietor?:No
Enumeration Date:2006-11-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALT00169183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL4941630001Medicare ID - Type Unspecified