Provider Demographics
NPI:1316206790
Name:HEALTH CARE AUTHORITY FOR BAPTIST HEALTH AN AFFILIATE OF UAB
Entity Type:Organization
Organization Name:HEALTH CARE AUTHORITY FOR BAPTIST HEALTH AN AFFILIATE OF UAB
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF PHARMACY
Authorized Official - Prefix:
Authorized Official - First Name:CARRIE
Authorized Official - Middle Name:
Authorized Official - Last Name:WEBB
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:334-273-2272
Mailing Address - Street 1:4145 CARMICHAEL RD
Mailing Address - Street 2:STE A
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36106-2803
Mailing Address - Country:US
Mailing Address - Phone:334-273-2281
Mailing Address - Fax:334-368-2936
Practice Address - Street 1:4145 CARMICHAEL RD
Practice Address - Street 2:STE A
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36106-2803
Practice Address - Country:US
Practice Address - Phone:334-273-2281
Practice Address - Fax:334-368-2936
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-07
Last Update Date:2017-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336S0011X
AL1117633336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL145677Medicaid
2134999OtherPK