Healthcare Provider Details

I. General information

NPI: 1588604334
Provider Name (Legal Business Name): JEFFERSON HEALTH SYSTEM PHARMACY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/08/2006
Last Update Date: 12/18/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2817 30TH AVE N
BIRMINGHAM AL
35207-4541
US

IV. Provider business mailing address

601 WEST BLVD
BIRMINGHAM AL
35206-1300
US

V. Phone/Fax

Practice location:
  • Phone: 205-521-6855
  • Fax: 205-521-6854
Mailing address:
  • Phone: 205-838-4310
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336C0002X
TaxonomyClinic Pharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number140009
License Number StateAL

VIII. Authorized Official

Name: GLEN THOMPSON
Title or Position: DIRECTOR OF PHARMACY
Credential:
Phone: 205-918-2352