Healthcare Provider Details

I. General information

NPI: 1073187746
Provider Name (Legal Business Name): ELAINE MICHAELS RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/18/2021
Last Update Date: 05/18/2021
Certification Date: 05/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

619 19TH ST S # JT1728
BIRMINGHAM AL
35233-1900
US

IV. Provider business mailing address

619 19TH ST S # JT1728
BIRMINGHAM AL
35233-1900
US

V. Phone/Fax

Practice location:
  • Phone: 205-975-5656
  • Fax: 205-934-0140
Mailing address:
  • Phone: 205-975-5656
  • Fax: 205-934-0140

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number11798
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: