Healthcare Provider Details

I. General information

NPI: 1376032847
Provider Name (Legal Business Name): UNIVERSITY OF SOUTH ALABAMA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/09/2018
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1660 SPRING HILL AVE
MOBILE AL
36604-1405
US

IV. Provider business mailing address

1660 SPRING HILL AVE
MOBILE AL
36604-1405
US

V. Phone/Fax

Practice location:
  • Phone: 251-410-6337
  • Fax: 251-410-4955
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336M0002X
TaxonomyMail Order Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: CAROLYN DEMOUY
Title or Position: PHARMACY COORDINATOR
Credential:
Phone: 251-410-6337