Provider Demographics
NPI:1023121191
Name:POWERS, MICHEAL ALAN (RPH)
Entity type:Individual
Prefix:
First Name:MICHEAL
Middle Name:ALAN
Last Name:POWERS
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 1:104 CLEAR SPRINGS CIR
Mailing Address - Street 2:
Mailing Address - City:HAZEL GREEN
Mailing Address - State:AL
Mailing Address - Zip Code:35750-4601
Mailing Address - Country:US
Mailing Address - Phone:256-828-9540
Mailing Address - Fax:
Practice Address - Street 1:13574 HIGHWAY 231 431 N STE B
Practice Address - Street 2:
Practice Address - City:HAZEL GREEN
Practice Address - State:AL
Practice Address - Zip Code:35750-8642
Practice Address - Country:US
Practice Address - Phone:256-813-0150
Practice Address - Fax:256-813-0149
Is Sole Proprietor?:No
Enumeration Date:2006-08-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL11561183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL11561OtherSTATE PHARMACY LICENSE