Provider Demographics
NPI:1972728624
Name:MAISE, DORIS PUTMAN (RPH)
Entity Type:Individual
Prefix:MRS
First Name:DORIS
Middle Name:PUTMAN
Last Name:MAISE
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:821 CROSSHILL LANE
Mailing Address - Street 2:
Mailing Address - City:WARRIOR
Mailing Address - State:AL
Mailing Address - Zip Code:35180-5540
Mailing Address - Country:US
Mailing Address - Phone:205-647-6635
Mailing Address - Fax:
Practice Address - Street 1:1152 EASTLAKE BLVD
Practice Address - Street 2:
Practice Address - City:TARRANT CITY
Practice Address - State:AL
Practice Address - Zip Code:35217
Practice Address - Country:US
Practice Address - Phone:205-841-6421
Practice Address - Fax:205-841-2405
Is Sole Proprietor?:No
Enumeration Date:2007-04-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL7115183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist