Provider Demographics
NPI:1265537518
Name:HELLUMS, MAC WALLACE (PHARMD)
Entity type:Individual
Prefix:DR
First Name:MAC
Middle Name:WALLACE
Last Name:HELLUMS
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:613 19TH CT S
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35205-6405
Mailing Address - Country:US
Mailing Address - Phone:250-383-4180
Mailing Address - Fax:
Practice Address - Street 1:450 RIVERCHASE PKWY E
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35244-2858
Practice Address - Country:US
Practice Address - Phone:205-220-7379
Practice Address - Fax:205-220-2939
Is Sole Proprietor?:No
Enumeration Date:2006-09-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL15348183500000X
TN24229183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist