Healthcare Provider Details

I. General information

NPI: 1083715866
Provider Name (Legal Business Name): EDWIN CLAYTON PUTMAN RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/26/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 SOUTH 19TH STREET (119)
BIRMINGHAM AL
35233
US

IV. Provider business mailing address

1203 WOODLAND VILLAGE
BIRMINGHAM AL
35216
US

V. Phone/Fax

Practice location:
  • Phone: 205-933-8101
  • Fax: 205-555-4784
Mailing address:
  • Phone: 205-933-8101
  • Fax: 205-558-4784

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number9707
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: