=====================================================
General NPI Number Information
=====================================================
NPI Number | 1477926657
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ALABAMA SPECIALTY RX LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/10/2015
-----------------------------------------------------
Last Update Date | 04/13/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2728 10TH AVE S STE 340
-----------------------------------------------------
City | BIRMINGHAM
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 35205-1202
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 205-263-9735
-----------------------------------------------------
Fax | 205-939-4413
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2728 10TH AVE S SUITE 340
-----------------------------------------------------
City | BIRMINGHAM
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 35205-1202
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 205-263-9735
-----------------------------------------------------
Fax | 205-939-4413
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | EXECUTIVE DIRECTOR
-----------------------------------------------------
Name | CHRIS BARNES
-----------------------------------------------------
Credential | PHARMD
-----------------------------------------------------
Telephone | 205-803-4333
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 333600000X
-----------------------------------------------------
Taxonomy Name | Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number | 114549
-----------------------------------------------------
License Number State | AL
-----------------------------------------------------