Healthcare Provider Details

I. General information

NPI: 1710015649
Provider Name (Legal Business Name): ANGELA BAILEY ROWSEY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/01/2007
Last Update Date: 10/31/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

315 W MAIN ST
CHARLESTON MS
38921-2232
US

IV. Provider business mailing address

126 COURT SQUARE
CHARLESTON MS
38921-2232
US

V. Phone/Fax

Practice location:
  • Phone: 662-647-5541
  • Fax: 662-647-5546
Mailing address:
  • Phone: 662-783-6100
  • Fax: 662-783-3007

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberE-08803
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: