Healthcare Provider Details

I. General information

NPI: 1578457479
Provider Name (Legal Business Name): ALI LANDRY PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2025
Last Update Date: 06/05/2025
Certification Date: 06/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5811 JACK SPRINGS RD
ATMORE AL
36502-5025
US

IV. Provider business mailing address

10472 SHETLAND DR
SPANISH FORT AL
36527-5903
US

V. Phone/Fax

Practice location:
  • Phone: 251-368-9136
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number23147
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: