MEDICARE: STATE OF MISSISSIPPI-UNIVERSITY OF MISSISSIPPI MEDICAL CENTER

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	04116	MS

Other Identifiers

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

General Provider Information

NPI Number	:	1932144342
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STATE OF MISSISSIPPI-UNIVERSITY OF MISSISSIPPI MEDICAL CENTER

Provider Business Mailing Address
First Line	:	350 W WOODROW WILSON AVE
Second Line	:	SUITE 501
City	:	JACKSON
State	:	MS
Zip	:	39213-7681
Country	:	US
Telephone Number	:	601-815-3857
Fax Number	:	601-815-8901

Provider Business Practice Location Address
First Line	:	350 W WOODROW WILSON AVE
Second Line	:	SUITE 501
City	:	JACKSON
State	:	MS
Zip	:	39213-7681
Country	:	US
Telephone Number	:	601-815-3857
Fax Number	:	601-815-8901

Authorized Official
Title or Position	:	ASSISTANT DIRECTOR OF PHARMACY
Name	:	DR. STEVEN DANCER
Credential	:	PHARM.D.
Telephone Number	:	601-815-8902

Provider Enumeration Date	:	06/19/2006
Last Update Date	:	11/11/2020

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Directions to “STATE OF MISSISSIPPI-UNIVERSITY OF MISSISSIPPI MEDICAL CENTER ” Practice Location

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