Provider Demographics
NPI:1346038916
Name:DERRISO, EVELYN ALLEN (PHARMD)
Entity type:Individual
Prefix:DR
First Name:EVELYN
Middle Name:ALLEN
Last Name:DERRISO
Suffix:
Gender:
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:414 WESTWOOD PL
Mailing Address - Street 2:
Mailing Address - City:HOMEWOOD
Mailing Address - State:AL
Mailing Address - Zip Code:35209-6952
Mailing Address - Country:US
Mailing Address - Phone:205-767-8655
Mailing Address - Fax:
Practice Address - Street 1:2708 7TH AVE S
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35233-3406
Practice Address - Country:US
Practice Address - Phone:205-297-0075
Practice Address - Fax:205-297-0074
Is Sole Proprietor?:No
Enumeration Date:2025-04-25
Last Update Date:2025-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL139051835N0905X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835N0905XPharmacy Service ProvidersPharmacistNuclear