Provider Demographics
NPI:1144529280
Name:GENTRY, JOHN MORGAN (RPH)
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:MORGAN
Last Name:GENTRY
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:PO BOX 510
Mailing Address - Street 2:
Mailing Address - City:SNEAD
Mailing Address - State:AL
Mailing Address - Zip Code:35952-0510
Mailing Address - Country:US
Mailing Address - Phone:205-466-7990
Mailing Address - Fax:205-466-3603
Practice Address - Street 1:87458 US HIGHWAY 278
Practice Address - Street 2:
Practice Address - City:ALTOONA
Practice Address - State:AL
Practice Address - Zip Code:35952-9638
Practice Address - Country:US
Practice Address - Phone:205-466-7990
Practice Address - Fax:205-466-3603
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-15
Last Update Date:2011-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL7897183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL100001501Medicaid