Provider Demographics
NPI:1265133177
Name:ELMORE, ALEX (PHARMD)
Entity type:Individual
Prefix:
First Name:ALEX
Middle Name:
Last Name:ELMORE
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 1:70 COUNTRY LANE PVT DR
Mailing Address - Street 2:
Mailing Address - City:SOMERVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35670-7000
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1380 OLD HIGHWAY 24
Practice Address - Street 2:
Practice Address - City:TRINITY
Practice Address - State:AL
Practice Address - Zip Code:35673-5600
Practice Address - Country:US
Practice Address - Phone:256-350-3365
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-16
Last Update Date:2023-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL22523183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist