Basic Information
| Provider Information | |||||||||
| NPI: | 1366828055 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | SAMFORD UNIVERSITY | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1400 6TH AVE S | ||||||||
| Address2: | |||||||||
| City: | BIRMINGHAM | ||||||||
| State: | AL | ||||||||
| PostalCode: | 352331502 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2099301153 | ||||||||
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| Practice Location | |||||||||
| Address1: | 800 LAKESHORE DRIVE | ||||||||
| Address2: | |||||||||
| City: | BIRMINGHAM | ||||||||
| State: | AL | ||||||||
| PostalCode: | 35229 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2057262635 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/04/2015 | ||||||||
| LastUpdateDate: | 12/02/2015 | ||||||||
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| AuthorizedOfficialLastName: | SUNG | ||||||||
| AuthorizedOfficialFirstName: | HANNA | ||||||||
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| AuthorizedOfficialTitleorPosition: | PHARMACIST | ||||||||
| AuthorizedOfficialTelephone: | 7146181890 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | PHARM.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 183500000X | 18866 | AL | Y | 193400000X SINGLE SPECIALTY GROUP | Pharmacy Service Providers | Pharmacist |
No ID Information.