1346038916 NPI number — DR. EVELYN ALLEN DERRISO PHARMD

Table of content: DR. EVELYN ALLEN DERRISO PHARMD (NPI 1346038916)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1346038916 NPI number — DR. EVELYN ALLEN DERRISO PHARMD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DERRISO
Provider First Name:
EVELYN
Provider Middle Name:
ALLEN
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PHARMD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1346038916
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/25/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
414 WESTWOOD PL
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HOMEWOOD
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
35209-6952
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
205-767-8655
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2708 7TH AVE S
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BIRMINGHAM
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35233-3406
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
205-297-0075
Provider Business Practice Location Address Fax Number:
205-297-0074
Provider Enumeration Date:
04/25/2025

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1835N0905X , with the licence number:  13905 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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