Provider Demographics
NPI:1548676018
Name:CHAMPION, MEGAN (PHARM D)
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:
Last Name:CHAMPION
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1620 ROSS CLARK CIR
Mailing Address - Street 2:
Mailing Address - City:DOTHAN
Mailing Address - State:AL
Mailing Address - Zip Code:36301-5439
Mailing Address - Country:US
Mailing Address - Phone:334-673-1208
Mailing Address - Fax:334-673-1215
Practice Address - Street 1:1620 ROSS CLARK CIR
Practice Address - Street 2:
Practice Address - City:DOTHAN
Practice Address - State:AL
Practice Address - Zip Code:36301-5439
Practice Address - Country:US
Practice Address - Phone:334-673-1208
Practice Address - Fax:334-673-1215
Is Sole Proprietor?:No
Enumeration Date:2014-07-06
Last Update Date:2014-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL17726183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist