Healthcare Provider Details

I. General information

NPI: 1972769834
Provider Name (Legal Business Name): ADVANCED SPECIALTY PHARMACY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/31/2008
Last Update Date: 01/18/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 OXMOOR RD STE 118
BIRMINGHAM AL
35209-5979
US

IV. Provider business mailing address

102 OXMOOR RD STE 118
BIRMINGHAM AL
35209-5979
US

V. Phone/Fax

Practice location:
  • Phone: 205-941-9848
  • Fax: 888-481-2041
Mailing address:
  • Phone: 205-941-9848
  • Fax: 888-481-2041

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number113100
License Number StateAL
# 3
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: WILLIAM ROGERS
Title or Position: PRESIDENT
Credential: RPH
Phone: 205-941-9848