Healthcare Provider Details

I. General information

NPI: 1063590321
Provider Name (Legal Business Name): SUZANNE M. VERNON R.PH.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/02/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5511 HIGHWAY 280 GREYSTONE PARK SUITE 301
BIRMINGHAM AL
35242-6585
US

IV. Provider business mailing address

1020 ROYAL MILE
BIRMINGHAM AL
35242-6061
US

V. Phone/Fax

Practice location:
  • Phone: 205-995-8388
  • Fax: 205-995-8897
Mailing address:
  • Phone: 205-527-1533
  • Fax: 205-995-8897

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number12806
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: