Healthcare Provider Details

I. General information

NPI: 1124503495
Provider Name (Legal Business Name): MICHAEL EDWARD BONDS RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/02/2018
Last Update Date: 10/02/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 ALCORN DR
CORINTH MS
38834-9359
US

IV. Provider business mailing address

111 ALCORN DR
CORINTH MS
38834-9359
US

V. Phone/Fax

Practice location:
  • Phone: 662-286-6991
  • Fax: 662-287-6280
Mailing address:
  • Phone: 662-286-6991
  • Fax: 662-287-6280

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberE-07534
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: