Healthcare Provider Details

I. General information

NPI: 1063750693
Provider Name (Legal Business Name): EVA RENEE SISK PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/16/2013
Last Update Date: 01/16/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1325 MONTCLAIR RD
IRONDALE AL
35210-2205
US

IV. Provider business mailing address

1325 MONTCLAIR RD
IRONDALE AL
35210-2205
US

V. Phone/Fax

Practice location:
  • Phone: 205-951-6632
  • Fax: 205-951-6637
Mailing address:
  • Phone: 205-951-6632
  • Fax: 205-951-6637

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number13638
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: