Provider Demographics
NPI:1932215670
Name:POWELL, ALICESON ALENA
Entity Type:Individual
Prefix:MISS
First Name:ALICESON
Middle Name:ALENA
Last Name:POWELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:RR 1 BOX 75
Mailing Address - Street 2:
Mailing Address - City:SAINT GEORGE
Mailing Address - State:GA
Mailing Address - Zip Code:31562-9706
Mailing Address - Country:US
Mailing Address - Phone:912-843-2010
Mailing Address - Fax:
Practice Address - Street 1:RR 1 BOX 75
Practice Address - Street 2:
Practice Address - City:SAINT GEORGE
Practice Address - State:GA
Practice Address - Zip Code:31562-9706
Practice Address - Country:US
Practice Address - Phone:912-843-2010
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician