Healthcare Provider Details

I. General information

NPI: 1083036016
Provider Name (Legal Business Name): C AND K PHARMACY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/10/2014
Last Update Date: 08/30/2021
Certification Date: 08/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 SUNSET DR
GRENADA MS
38901-4613
US

IV. Provider business mailing address

350 SUNSET DR
GRENADA MS
38901-4613
US

V. Phone/Fax

Practice location:
  • Phone: 662-307-2221
  • Fax: 662-307-2438
Mailing address:
  • Phone: 662-307-2221
  • Fax: 662-307-2438

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number12961/1.1
License Number StateMS

VIII. Authorized Official

Name: CHRISTY HUDSON
Title or Position: PRESIDENT
Credential:
Phone: 662-307-2221