Provider Demographics
NPI:1184153058
Name:FUSSELL, KATIE REBECCA (PHARM D)
Entity type:Individual
Prefix:
First Name:KATIE
Middle Name:REBECCA
Last Name:FUSSELL
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:DR
Other - First Name:KATIE
Other - Middle Name:F
Other - Last Name:LOCKHART
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARM D
Mailing Address - Street 1:1415 7TH ST S
Mailing Address - Street 2:
Mailing Address - City:CLANTON
Mailing Address - State:AL
Mailing Address - Zip Code:35045-3746
Mailing Address - Country:US
Mailing Address - Phone:205-755-5728
Mailing Address - Fax:205-755-9477
Practice Address - Street 1:1415 7TH ST S
Practice Address - Street 2:
Practice Address - City:CLANTON
Practice Address - State:AL
Practice Address - Zip Code:35045-3746
Practice Address - Country:US
Practice Address - Phone:205-755-5728
Practice Address - Fax:205-755-9477
Is Sole Proprietor?:No
Enumeration Date:2017-06-05
Last Update Date:2017-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL17083183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist