Provider Demographics
NPI:1952619231
Name:EMERINE, GARY KEITH (RPH)
Entity Type:Individual
Prefix:MR
First Name:GARY
Middle Name:KEITH
Last Name:EMERINE
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3925 CROSSHAVEN DR
Mailing Address - Street 2:
Mailing Address - City:VESTAVIA
Mailing Address - State:AL
Mailing Address - Zip Code:35243-5416
Mailing Address - Country:US
Mailing Address - Phone:205-969-1260
Mailing Address - Fax:205-969-2679
Practice Address - Street 1:3925 CROSSHAVEN DR
Practice Address - Street 2:
Practice Address - City:VESTAVIA
Practice Address - State:AL
Practice Address - Zip Code:35243-5416
Practice Address - Country:US
Practice Address - Phone:205-969-1260
Practice Address - Fax:205-969-2679
Is Sole Proprietor?:No
Enumeration Date:2010-09-20
Last Update Date:2015-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL9998183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL183500000XOtherPHARMACIST TAXONOMY CODE