Provider Demographics
NPI:1972948834
Name:JERNIGAN, WILLIAM GILBERT (PHARMD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:GILBERT
Last Name:JERNIGAN
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:141 E GLENWOOD DR
Mailing Address - Street 2:
Mailing Address - City:HOMEWOOD
Mailing Address - State:AL
Mailing Address - Zip Code:35209-3949
Mailing Address - Country:US
Mailing Address - Phone:423-782-7707
Mailing Address - Fax:
Practice Address - Street 1:141 E GLENWOOD DR
Practice Address - Street 2:
Practice Address - City:HOMEWOOD
Practice Address - State:AL
Practice Address - Zip Code:35209-3949
Practice Address - Country:US
Practice Address - Phone:423-782-7707
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-06
Last Update Date:2016-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL19482183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist