Healthcare Provider Details

I. General information

NPI: 1548181415
Provider Name (Legal Business Name): ADELINE GRACE DAVIS PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ADELINE LEE

II. Dates (important events)

Enumeration Date: 07/24/2026
Last Update Date: 07/24/2026
Certification Date: 07/24/2026
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: 205-934-4630
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number24644
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: