Healthcare Provider Details

I. General information

NPI: 1811615271
Provider Name (Legal Business Name): WYNA LAVAS HEBSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2022
Last Update Date: 08/19/2022
Certification Date: 08/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 6TH AVE S
BIRMINGHAM AL
35233-2110
US

IV. Provider business mailing address

2000 6TH AVE S
BIRMINGHAM AL
35233-2110
US

V. Phone/Fax

Practice location:
  • Phone: 205-801-8730
  • Fax: 205-801-8902
Mailing address:
  • Phone: 205-801-8730
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number9292
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: