Healthcare Provider Details

I. General information

NPI: 1629996624
Provider Name (Legal Business Name): KARDARIUS FELTON
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/07/2026
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 HOSPITAL CIR
CHOCTAW MS
39350-6781
US

IV. Provider business mailing address

210 HOSPITAL CIR
CHOCTAW MS
39350-6781
US

V. Phone/Fax

Practice location:
  • Phone: 601-389-4332
  • Fax:
Mailing address:
  • Phone: 601-389-4332
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberE-102061
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: