Provider Demographics
NPI:1043061989
Name:SELF, FELICIA SMITH
Entity type:Individual
Prefix:MRS
First Name:FELICIA
Middle Name:SMITH
Last Name:SELF
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2086 COLUMBIANA RD STE 1100
Mailing Address - Street 2:
Mailing Address - City:VESTAVIA HILLS
Mailing Address - State:AL
Mailing Address - Zip Code:35216-2118
Mailing Address - Country:US
Mailing Address - Phone:205-552-1700
Mailing Address - Fax:
Practice Address - Street 1:2086 COLUMBIANA RD STE 1100
Practice Address - Street 2:
Practice Address - City:VESTAVIA HILLS
Practice Address - State:AL
Practice Address - Zip Code:35216-2118
Practice Address - Country:US
Practice Address - Phone:205-552-1700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-28
Last Update Date:2024-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL116661835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist