Healthcare Provider Details

I. General information

NPI: 1457255762
Provider Name (Legal Business Name): MOHAMED MARZOUK
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/08/2026
Last Update Date: 10/08/2026
Certification Date: 10/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2202 HIGHWAY 82 W
GREENWOOD MS
38930-2706
US

IV. Provider business mailing address

218 KAREN DR
OXFORD MS
38655-7077
US

V. Phone/Fax

Practice location:
  • Phone: 662-453-3967
  • Fax:
Mailing address:
  • Phone: 662-202-8544
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberE-102628
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: