Healthcare Provider Details

I. General information

NPI: 1194802892
Provider Name (Legal Business Name): JERRY'S PHARMACY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1532 HUFFMAN RD
BIRMINGHAM AL
35215-5621
US

IV. Provider business mailing address

1532 HUFFMAN RD
BIRMINGHAM AL
35215-5621
US

V. Phone/Fax

Practice location:
  • Phone: 205-853-1293
  • Fax:
Mailing address:
  • Phone: 205-853-1293
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number07008524
License Number StateAL

VIII. Authorized Official

Name: CHARLES JERRY GARRISON
Title or Position: OWNER/PHARMACIST
Credential: RPH.
Phone: 205-853-1293