Healthcare Provider Details

I. General information

NPI: 1881693653
Provider Name (Legal Business Name): HEALTH STRIDES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/14/2005
Last Update Date: 03/16/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4268 CAHABA HEIGHTS CT SUITE 103
VESTAVIA AL
35243-5711
US

IV. Provider business mailing address

4268 CAHABA HEIGHTS CT SUITE 103
VESTAVIA AL
35243-5711
US

V. Phone/Fax

Practice location:
  • Phone: 205-824-0775
  • Fax: 205-313-5791
Mailing address:
  • Phone: 205-824-0775
  • Fax: 205-313-5791

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number112116
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number112116
License Number StateAL
# 3
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number112116
License Number StateAL
# 4
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number112116
License Number StateAL

VIII. Authorized Official

Name: LEA MARIE WOLSONCROFT
Title or Position: PRESIDENT
Credential: RPH
Phone: 205-824-0775