Healthcare Provider Details

I. General information

NPI: 1801401278
Provider Name (Legal Business Name): DEVAN SMILEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/12/2020
Last Update Date: 09/12/2020
Certification Date: 09/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2400 HOSPITAL RD
TUSKEGEE AL
36083-5001
US

IV. Provider business mailing address

720 FORESTWOOD RD
BIRMINGHAM AL
35214-3312
US

V. Phone/Fax

Practice location:
  • Phone: 205-602-0206
  • Fax:
Mailing address:
  • Phone: 205-602-0206
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License NumberT26884
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: