Healthcare Provider Details

I. General information

NPI: 1972989770
Provider Name (Legal Business Name): JORDAN WULZ PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2015
Last Update Date: 08/04/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5720 1ST AVE S
BIRMINGHAM AL
35212
US

IV. Provider business mailing address

800 LAKESHORE DR.
BIRMINGHAM AL
35209
US

V. Phone/Fax

Practice location:
  • Phone: 205-380-9455
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number18822
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: