Provider Demographics
NPI:1942585187
Name:HASKEW, MEDFORD LAMAR (RPH)
Entity type:Individual
Prefix:MR
First Name:MEDFORD
Middle Name:LAMAR
Last Name:HASKEW
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 1:13612 PINE FOREST RD
Mailing Address - Street 2:
Mailing Address - City:ANDALUSIA
Mailing Address - State:AL
Mailing Address - Zip Code:36420-9263
Mailing Address - Country:US
Mailing Address - Phone:334-764-2196
Mailing Address - Fax:
Practice Address - Street 1:900 RUCKER BLVD
Practice Address - Street 2:
Practice Address - City:ENTERPRISE
Practice Address - State:AL
Practice Address - Zip Code:36330-2160
Practice Address - Country:US
Practice Address - Phone:334-393-1348
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-19
Last Update Date:2011-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL9211183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist