Healthcare Provider Details

I. General information

NPI: 1568457034
Provider Name (Legal Business Name): SPEIGHA HEALTH,INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/12/2005
Last Update Date: 06/21/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 MAIN STREET
BUDE MS
39630
US

IV. Provider business mailing address

PO BOX 129
BUDE MS
39630-0129
US

V. Phone/Fax

Practice location:
  • Phone: 601-384-2383
  • Fax: 601-384-1650
Mailing address:
  • Phone: 601-384-2383
  • Fax: 601-384-1650

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number00593/01.1
License Number StateMS

VIII. Authorized Official

Name: MRS. ALISA B SMITH
Title or Position: PHARMACIST IN CHARGE
Credential: RPH
Phone: 601-384-2383