Healthcare Provider Details

I. General information

NPI: 1619046851
Provider Name (Legal Business Name): JEFFERSON COUNTY COMMISSION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/06/2006
Last Update Date: 10/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2101 DANIEL PAYNE DR
BIRMINGHAM AL
35214-4855
US

IV. Provider business mailing address

2101 DANIEL PAYNE DR
BIRMINGHAM AL
35214-4855
US

V. Phone/Fax

Practice location:
  • Phone: 205-791-4720
  • Fax: 205-791-4726
Mailing address:
  • Phone: 205-791-4720
  • Fax: 205-791-4726

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336C0002X
TaxonomyClinic Pharmacy
License Number112801
License Number StateAL
# 2
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number112801
License Number StateAL

VIII. Authorized Official

Name: DR. GLEN A THOMPSON
Title or Position: DIRECTOR OF PHARMACY
Credential: PHARM.D.
Phone: 205-918-2352