Healthcare Provider Details

I. General information

NPI: 1548999436
Provider Name (Legal Business Name): FUNDERBURKS PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/07/2022
Last Update Date: 11/14/2022
Certification Date: 11/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4962 HIGHWAY 305 STE B
COLDWATER MS
38618-5821
US

IV. Provider business mailing address

134 W COMMERCE ST
HERNANDO MS
38632-2240
US

V. Phone/Fax

Practice location:
  • Phone: 901-487-0848
  • Fax:
Mailing address:
  • Phone: 901-487-0848
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: CHERYL M. SUDDUTH
Title or Position: PRESIDENT
Credential: RPH.
Phone: 662-429-5337