Provider Demographics
NPI:1861831059
Name:BREWER, MICKEY L (RPH)
Entity Type:Individual
Prefix:MR
First Name:MICKEY
Middle Name:L
Last Name:BREWER
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 1:9217 TURTLE POINT DR
Mailing Address - Street 2:
Mailing Address - City:KILLEN
Mailing Address - State:AL
Mailing Address - Zip Code:35645-2855
Mailing Address - Country:US
Mailing Address - Phone:256-757-5855
Mailing Address - Fax:256-757-5855
Practice Address - Street 1:9217 TURTLE POINT DR
Practice Address - Street 2:
Practice Address - City:KILLEN
Practice Address - State:AL
Practice Address - Zip Code:35645-2855
Practice Address - Country:US
Practice Address - Phone:256-757-5855
Practice Address - Fax:256-757-5855
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-20
Last Update Date:2013-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL13553183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist