Healthcare Provider Details

I. General information

NPI: 1477698595
Provider Name (Legal Business Name): HARBIN'S AT MT. ROYAL TOWERS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/20/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 ROYAL TOWER DR
BIRMINGHAM AL
35209-6865
US

IV. Provider business mailing address

1119 ROYAL TOWER DR
BIRMINGHAM AL
35209-6822
US

V. Phone/Fax

Practice location:
  • Phone: 205-423-0091
  • Fax: 205-423-0977
Mailing address:
  • Phone: 205-423-0091
  • Fax: 205-423-0977

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number111941
License Number StateAL

VIII. Authorized Official

Name: MR. JERRY GENE NEWMAN
Title or Position: CO-OWNER,PRESIDENT
Credential: RPH
Phone: 205-871-2196