Healthcare Provider Details

I. General information

NPI: 1376852723
Provider Name (Legal Business Name): GUINN TERRY DAVIS RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/04/2010
Last Update Date: 10/04/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

229 N UNION ST
CANTON MS
39046-3728
US

IV. Provider business mailing address

229 N UNION ST
CANTON MS
39046-3728
US

V. Phone/Fax

Practice location:
  • Phone: 601-859-4681
  • Fax: 601-859-0635
Mailing address:
  • Phone: 601-859-4681
  • Fax: 601-859-0635

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberE-6306
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: