Healthcare Provider Details

I. General information

NPI: 1649281288
Provider Name (Legal Business Name): COPD PHARMACY CONSULTANTS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/10/2006
Last Update Date: 04/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

132 FAIRMONT ST STE C
CLINTON MS
39056-4721
US

IV. Provider business mailing address

132 FAIRMONT ST SUITE C
CLINTON MS
39056-4721
US

V. Phone/Fax

Practice location:
  • Phone: 601-925-5822
  • Fax: 601-925-5812
Mailing address:
  • Phone: 601-925-5822
  • Fax: 601-925-5812

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number05801025
License Number StateMS

VIII. Authorized Official

Name: GEORGE CUTRER
Title or Position: PHARMACIST LLC MANAGER
Credential:
Phone: 601-925-5822