Provider Demographics
NPI:1427657758
Name:PRENDERGAST, ANN (RPH)
Entity type:Individual
Prefix:
First Name:ANN
Middle Name:
Last Name:PRENDERGAST
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4408 OVERLOOK RD
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35222-3746
Mailing Address - Country:US
Mailing Address - Phone:205-873-1093
Mailing Address - Fax:
Practice Address - Street 1:8551 WHITFIELD AVE
Practice Address - Street 2:
Practice Address - City:LEEDS
Practice Address - State:AL
Practice Address - Zip Code:35094-7560
Practice Address - Country:US
Practice Address - Phone:205-699-0701
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-19
Last Update Date:2020-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL14061183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist