Provider Demographics
NPI:1336448802
Name:TILL, MAX
Entity Type:Individual
Prefix:
First Name:MAX
Middle Name:
Last Name:TILL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8683 COUNTY ROAD 7
Mailing Address - Street 2:
Mailing Address - City:REPTON
Mailing Address - State:AL
Mailing Address - Zip Code:36475-6800
Mailing Address - Country:US
Mailing Address - Phone:251-248-2135
Mailing Address - Fax:251-248-2682
Practice Address - Street 1:8683 COUNTY ROAD 7
Practice Address - Street 2:
Practice Address - City:REPTON
Practice Address - State:AL
Practice Address - Zip Code:36475-6800
Practice Address - Country:US
Practice Address - Phone:251-248-2135
Practice Address - Fax:251-248-2682
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-22
Last Update Date:2011-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL7031183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist