Provider Demographics
NPI:1205372232
Name:AFFINITY MTM
Entity Type:Organization
Organization Name:AFFINITY MTM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHARMACIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:MALY
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:205-876-2658
Mailing Address - Street 1:501 RIVERCHASE PKWY E
Mailing Address - Street 2:SUITE 201
Mailing Address - City:HOOVER
Mailing Address - State:AL
Mailing Address - Zip Code:35244-1808
Mailing Address - Country:US
Mailing Address - Phone:205-876-2658
Mailing Address - Fax:888-205-3826
Practice Address - Street 1:501 RIVERCHASE PKWY E
Practice Address - Street 2:SUITE 201
Practice Address - City:HOOVER
Practice Address - State:AL
Practice Address - Zip Code:35244-1808
Practice Address - Country:US
Practice Address - Phone:205-876-2658
Practice Address - Fax:888-205-3826
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-14
Last Update Date:2017-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL8000171835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy SpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL800017OtherPHARMACY CONSULTING