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NPI Code Detail

MEDICARE: KELLY TATE PHARMD

MEDICARE: KELLY TATE PHARMD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1183500000XPharmacist14819AL

General Provider Information

NPI Number : 1396020467
Entity Type Code : Individual
Provider Name (Legal Business Name) : KELLY TATE PHARMD
Provider Business Mailing Address
First Line : 101 DOUG BAKER BLVD
Second Line :
City : BIRMINGHAM
State : AL
Zip : 35242-2675
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 101 DOUG BAKER BLVD
Second Line :
City : BIRMINGHAM
State : AL
Zip : 35242-2675
Country : US
Telephone Number : 205-437-9467
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/19/2011
Last Update Date : 10/19/2011

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Directions to “ KELLY TATE PHARMD” Practice Location

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