Healthcare Provider Details

I. General information

NPI: 1760481238
Provider Name (Legal Business Name): TOMIE ANN BOACKLE PHARM.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 07/18/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

619 19TH ST S
BIRMINGHAM AL
35249-1900
US

IV. Provider business mailing address

9580 MCPHERSON RD
WARRIOR AL
35180-2756
US

V. Phone/Fax

Practice location:
  • Phone: 205-801-8732
  • Fax: 205-801-8741
Mailing address:
  • Phone: 205-590-4453
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number13442
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: