Provider Demographics
NPI:1619046851
Name:JEFFERSON COUNTY COMMISSION
Entity Type:Organization
Organization Name:JEFFERSON COUNTY COMMISSION
Other - Org Name:JEFFERSON HEALTH SYSTEM PHARMACY #7
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF PHARMACY
Authorized Official - Prefix:DR
Authorized Official - First Name:GLEN
Authorized Official - Middle Name:A
Authorized Official - Last Name:THOMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:205-918-2352
Mailing Address - Street 1:2101 DANIEL PAYNE DR
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35214-4855
Mailing Address - Country:US
Mailing Address - Phone:205-791-4720
Mailing Address - Fax:205-791-4726
Practice Address - Street 1:2101 DANIEL PAYNE DR
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35214-4855
Practice Address - Country:US
Practice Address - Phone:205-791-4720
Practice Address - Fax:205-791-4726
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-06
Last Update Date:2008-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL112801333600000X, 3336C0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No3336C0002XSuppliersPharmacyClinic Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL100003703Medicaid