MEDICARE: ROBERT CLINT GENTRY 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
1	1835C0205X	Critical Care Pharmacist	15456	AL

General Provider Information

NPI Number	:	1720688799
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROBERT CLINT GENTRY PHARMD

Provider Business Mailing Address
First Line	:	2986 ALTADENA RIDGE DR
Second Line	:
City	:	VESTAVIA
State	:	AL
Zip	:	35243-4724
Country	:	US
Telephone Number	:	205-790-2120
Fax Number	:

Provider Business Practice Location Address
First Line	:	4700 CAHABA RIVER RD STE B
Second Line	:
City	:	BIRMINGHAM
State	:	AL
Zip	:	35243-2325
Country	:	US
Telephone Number	:	205-970-1983
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/29/2020
Last Update Date	:	10/29/2020

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