Healthcare Provider Details

I. General information

NPI: 1720067507
Provider Name (Legal Business Name): DENISE BERTELLA MORRIS RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 01/11/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5511 HIGHWAY 280 SUITE 301
BIRMINGHAM AL
35242-6585
US

IV. Provider business mailing address

2650 PADEN PL
VESTAVIA HILLS AL
35226-2823
US

V. Phone/Fax

Practice location:
  • Phone: 205-995-8388
  • Fax: 205-995-8897
Mailing address:
  • Phone: 205-995-8388
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number12297
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: