Provider Demographics
NPI:1881603603
Name:PREUITT, MICHAEL WAYNE (RPH)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:WAYNE
Last Name:PREUITT
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:404 SPARKMAN ST NW
Mailing Address - Street 2:
Mailing Address - City:HARTSELLE
Mailing Address - State:AL
Mailing Address - Zip Code:35640-2326
Mailing Address - Country:US
Mailing Address - Phone:256-773-1998
Mailing Address - Fax:256-751-0625
Practice Address - Street 1:404 SPARKMAN ST NW
Practice Address - Street 2:
Practice Address - City:HARTSELLE
Practice Address - State:AL
Practice Address - Zip Code:35640-2326
Practice Address - Country:US
Practice Address - Phone:256-773-1998
Practice Address - Fax:256-751-0625
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2017-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL12710183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist