Provider Demographics
NPI:1619199130
Name:WILLIAMS SCRIVENER, LISA (RPH)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:WILLIAMS SCRIVENER
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:WILLIAMS
Other - Last Name:SCRIVENER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RPH
Mailing Address - Street 1:1600 BERRY RD
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35226-3217
Mailing Address - Country:US
Mailing Address - Phone:205-290-0053
Mailing Address - Fax:
Practice Address - Street 1:1515 6TH AVE S
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35233-1601
Practice Address - Country:US
Practice Address - Phone:205-930-3573
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL11303183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist