Healthcare Provider Details

I. General information

NPI: 1366478091
Provider Name (Legal Business Name): CHOCTAW HEALTH CENTER PHARMACY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/24/2006
Last Update Date: 04/01/2015
Certification Date:
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: 601-389-4330
  • Fax: 601-389-4331
Mailing address:
  • Phone: 601-389-4330
  • Fax: 601-389-4331

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code332800000X
TaxonomyIndian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: CHARLES MCKEE
Title or Position: CHIEF PHCIST
Credential: PHARM.D.
Phone: 601-389-4332