Individual
MR. JEFFREY ROBERT WALLER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
2185 REEVES ST, DOTHAN, AL 36303-2349
(334) 794-0623
(334) 794-9526
Mailing address
2185 REEVES ST, DOTHAN, AL 36303-2349
(334) 794-0623
(334) 794-9526
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
11941
AL
Other
Enumeration date
09/23/2013
Last updated
09/23/2013
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