Healthcare Provider Details

I. General information

NPI: 1437253168
Provider Name (Legal Business Name): UNIVERSITY OF ALABAMA AT BIRMINGHAM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/12/2006
Last Update Date: 11/12/2024
Certification Date: 11/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 19TH ST S 4TH FLOOR QT
BIRMINGHAM AL
35249-0001
US

IV. Provider business mailing address

601 19TH ST S 4TH FLOOR QT
BIRMINGHAM AL
35249-0001
US

V. Phone/Fax

Practice location:
  • Phone: 205-934-2661
  • Fax: 205-975-2562
Mailing address:
  • Phone: 205-934-2661
  • Fax: 205-975-2562

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: JENNIFER PETERSON
Title or Position: DIRECTOR OF AMBULATORY OPERATI
Credential: PHARMD
Phone: 205-934-7862