Active NPI
Andrew Wallace, PHARMD, RPH
- Pharmacist
- Birmingham, AL
National Provider Identifier
1669960795
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 19116
- Practice address
- 413 19TH Street Ensley
Birmingham, AL 35218-1601 - Phone
- (205) 787-4671
- Fax
- (205) 788-0450
- NPI assigned
- Apr 24, 2018
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 19116 | AL | Primary |
Addresses
Primary practice location
413 19TH Street Ensley
Birmingham, AL 35218-1601
Mailing address
1440 Oakridge Dr
Birmingham, AL 35242-3522
Phone (205) 413-2297
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Pharmacy, Registered Pharmacist
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 19116 | AL | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Gilmer Drug Company Inc. | Pharmacist | Current | Accepting new patients |
| TRC Pharmacy Inc | Pharmacist | Current | Accepting new patients |
Locations
413 19th Street Ensley
Ensley, AL 35218
Phone (205) 787-4671
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1524528000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1524528000000",
"number": "1669960795",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1440 OAKRIDGE DR",
"city": "BIRMINGHAM",
"state": "AL",
"postal_code": "352423522",
"telephone_number": "205-413-2297"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "413 19TH STREET ENSLEY",
"city": "BIRMINGHAM",
"state": "AL",
"postal_code": "352181601",
"telephone_number": "205-787-4671",
"fax_number": "205-788-0450"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WALLACE",
"first_name": "ANDREW",
"name_prefix": "Dr.",
"credential": "PHARMD, RPH",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2018-04-24",
"last_updated": "2018-04-24",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "AL",
"license": "19116",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Birmingham, AL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 24, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.