Healthcare Provider Details

I. General information

NPI: 1598734576
Provider Name (Legal Business Name): JULIA C TENNIN PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 03/14/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1883 HIGHWAY 43 S SUITE A
CANTON MS
39046-8405
US

IV. Provider business mailing address

1883 HWY 43 SOUTH SUITE A
CANTON MS
39046
US

V. Phone/Fax

Practice location:
  • Phone: 601-407-1440
  • Fax: 601-407-1441
Mailing address:
  • Phone: 601-407-1440
  • Fax: 601-407-1441

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberE7245
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: