Healthcare Provider Details

I. General information

NPI: 1669050860
Provider Name (Legal Business Name): DANIEL BENTON BRACKIN PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2021
Last Update Date: 03/30/2021
Certification Date: 03/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 11TH AVE S
BIRMINGHAM AL
35205-3423
US

IV. Provider business mailing address

1100 27TH ST S APT 503
BIRMINGHAM AL
35205-1712
US

V. Phone/Fax

Practice location:
  • Phone: 205-930-7171
  • Fax:
Mailing address:
  • Phone: 205-427-2293
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835C0205X
TaxonomyCritical Care Pharmacist
License Number16434
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: