Provider Demographics
NPI:1295074698
Name:FLOYD, JOHN WALLACE (R PH)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:WALLACE
Last Name:FLOYD
Suffix:
Gender:M
Credentials:R PH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:629 OAK GLEN DR
Mailing Address - Street 2:
Mailing Address - City:HOOVER
Mailing Address - State:AL
Mailing Address - Zip Code:35244-3250
Mailing Address - Country:US
Mailing Address - Phone:205-612-9361
Mailing Address - Fax:
Practice Address - Street 1:3107 LURLEEN B WALLACE BLVD
Practice Address - Street 2:
Practice Address - City:NORTHPORT
Practice Address - State:AL
Practice Address - Zip Code:35476-3256
Practice Address - Country:US
Practice Address - Phone:205-333-9343
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-02-05
Last Update Date:2013-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX21764183500000X
AL16069183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist