Provider Demographics
NPI:1700301470
Name:MONTGOMERY, CAROLE ANN (RPH)
Entity Type:Individual
Prefix:MRS
First Name:CAROLE
Middle Name:ANN
Last Name:MONTGOMERY
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1207 4TH ST NW P.O. BOX 1301
Mailing Address - Street 2:
Mailing Address - City:RED BAY
Mailing Address - State:AL
Mailing Address - Zip Code:35582-1301
Mailing Address - Country:US
Mailing Address - Phone:256-810-9270
Mailing Address - Fax:
Practice Address - Street 1:WALMART PHARMACY
Practice Address - Street 2:13675 US-43
Practice Address - City:RUSSELLVILLE
Practice Address - State:AL
Practice Address - Zip Code:35653
Practice Address - Country:US
Practice Address - Phone:256-332-7394
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-03
Last Update Date:2017-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL11096183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist