Healthcare Provider Details

I. General information

NPI: 1720688799
Provider Name (Legal Business Name): ROBERT CLINT GENTRY PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/29/2020
Last Update Date: 10/29/2020
Certification Date: 10/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4700 CAHABA RIVER RD STE B
BIRMINGHAM AL
35243-2325
US

IV. Provider business mailing address

2986 ALTADENA RIDGE DR
VESTAVIA AL
35243-4724
US

V. Phone/Fax

Practice location:
  • Phone: 205-970-1983
  • Fax:
Mailing address:
  • Phone: 205-790-2120
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835C0205X
TaxonomyCritical Care Pharmacist
License Number15456
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: