Healthcare Provider Details

I. General information

NPI: 1306367057
Provider Name (Legal Business Name): TINA HERRON RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

430 SCHOOL ST
CORDOVA AL
35550-6000
US

IV. Provider business mailing address

430 SCHOOL ST
CORDOVA AL
35550-6000
US

V. Phone/Fax

Practice location:
  • Phone: 205-483-7811
  • Fax: 205-483-7821
Mailing address:
  • Phone: 205-483-7811
  • Fax: 205-483-7821

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P2201X
TaxonomyAmbulatory Care Pharmacist
License Number12039
License Number StateAL

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: