MEDICARE: CONDONS EAST UNION PHARMACY INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	333600000X	Pharmacy
2	3336C0003X	Community/Retail Pharmacy	00457	MS

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2050808	OTHER		PK
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1043303480
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CONDONS EAST UNION PHARMACY INC

Provider Business Mailing Address
First Line	:	1403 E UNION ST
Second Line	:
City	:	GREENVILLE
State	:	MS
Zip	:	38703-3247
Country	:	US
Telephone Number	:	662-332-0941
Fax Number	:	662-378-8371

Provider Business Practice Location Address
First Line	:	1403 E UNION ST
Second Line	:
City	:	GREENVILLE
State	:	MS
Zip	:	38703-3247
Country	:	US
Telephone Number	:	662-332-0941
Fax Number	:	662-378-8371

Authorized Official
Title or Position	:	RPH
Name	:	HOWARD CHRISTIAN
Credential	:	RPH
Telephone Number	:	662-332-0941

Provider Enumeration Date	:	09/30/2006
Last Update Date	:	09/18/2014

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