Healthcare Provider Details

I. General information

NPI: 1497497960
Provider Name (Legal Business Name): DHP BROOKHAVEN, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/13/2022
Last Update Date: 07/26/2022
Certification Date: 07/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1037 HIGHWAY 84 E
BROOKHAVEN MS
39601-8776
US

IV. Provider business mailing address

1037 HIGHWAY 84 E
BROOKHAVEN MS
39601-8776
US

V. Phone/Fax

Practice location:
  • Phone: 601-967-8411
  • Fax: 833-481-3378
Mailing address:
  • Phone: 601-695-0210
  • Fax: 601-756-2001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: JAMES EARL CRANE
Title or Position: PRESIDENT/OWNER/RPH
Credential:
Phone: 601-967-8411