MEDICARE: UNIVERSITY OF ALABAMA AT BIRMINGHAM

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
1	3336C0002X	Clinic Pharmacy	111175	AL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1993075	OTHER		PK
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1437258373
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	UNIVERSITY OF ALABAMA AT BIRMINGHAM

Provider Business Mailing Address
First Line	:	1201 11TH AVE S
Second Line	:	3RD FLOOR PHARMACY
City	:	BIRMINGHAM
State	:	AL
Zip	:	35205-3410
Country	:	US
Telephone Number	:	205-930-7585
Fax Number	:	205-930-7587

Provider Business Practice Location Address
First Line	:	930 20TH ST S
Second Line	:
City	:	BIRMINGHAM
State	:	AL
Zip	:	35205-2610
Country	:	US
Telephone Number	:	205-975-7792
Fax Number	:	205-975-6962

Authorized Official
Title or Position	:	DIRECTOR OF AMBULATORY OPERATI
Name	:	JENNIFER PETERSON
Credential	:	PHARMD
Telephone Number	:	205-934-7862

Provider Enumeration Date	:	09/21/2006
Last Update Date	:	12/12/2014

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