Healthcare Provider Details

I. General information

NPI: 1629998455
Provider Name (Legal Business Name): SYDNEY ELIZABETH BONNER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2026
Last Update Date: 07/20/2026
Certification Date: 07/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 LAKESHORE DR
BIRMINGHAM AL
35229-0001
US

IV. Provider business mailing address

5991 OLD ACTON RD
MOODY AL
35004-2707
US

V. Phone/Fax

Practice location:
  • Phone: 205-726-2820
  • Fax:
Mailing address:
  • Phone: 205-726-2820
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License NumberT65412
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: