Healthcare Provider Details

I. General information

NPI: 1548854797
Provider Name (Legal Business Name): MRS. AMANDA LEA KIMBERLY GUINN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/26/2021
Last Update Date: 02/26/2021
Certification Date: 02/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1926 BYNUM BLVD
EASTABOGA AL
36260-5431
US

IV. Provider business mailing address

7101 LAKE RUN CIR
VESTAVIA AL
35242-7500
US

V. Phone/Fax

Practice location:
  • Phone: 256-237-7533
  • Fax: 256-237-7537
Mailing address:
  • Phone: 205-552-2784
  • Fax: 256-237-7537

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number15434
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: