Provider Demographics
NPI:1184752875
Name:BROCKWAY, AMY E
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:E
Last Name:BROCKWAY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1161 BERWICK RD
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35242-7121
Mailing Address - Country:US
Mailing Address - Phone:205-995-2665
Mailing Address - Fax:205-951-2357
Practice Address - Street 1:1337 MONTCLAIR RD
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35210-2205
Practice Address - Country:US
Practice Address - Phone:205-956-0400
Practice Address - Fax:205-951-2357
Is Sole Proprietor?:No
Enumeration Date:2007-03-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL13265183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist