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General NPI Number Information
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NPI Number | 1902245020
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Entity Type | Organization
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Legal Business Name | PEDS RX PHARMACY SOLUTIONS
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Dates
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Enumeration Date | 06/21/2013
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Last Update Date | 01/13/2023
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Provider Practice Location Address
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Address Line | 1600 7TH AVE S
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City | BIRMINGHAM
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State | AL
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Zip | 35233-1711
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Country | US
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Telephone | 205-983-8727
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Fax | 205-930-3681
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Provider Business Mailing Address
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Address Line | PO BOX 550028
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City | BIRMINGHAM
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State | AL
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Zip | 35255-0028
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Country | US
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Telephone | 205-960-5382
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Fax |
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Authorized Official
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Title or Position | PHARMACY MANAGER
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Name | DR. SAMUEL ASKIA BLAKEMORE
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Credential | PHARMD
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Telephone | 205-983-8727
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 114154
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License Number State | AL
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