Healthcare Provider Details

I. General information

NPI: 1770178238
Provider Name (Legal Business Name): JAMES ADAM MIXON PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/06/2021
Last Update Date: 03/06/2021
Certification Date: 03/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4300 15TH ST STE 1
GULFPORT MS
39501-2524
US

IV. Provider business mailing address

4300 15TH ST STE 1
GULFPORT MS
39501-2524
US

V. Phone/Fax

Practice location:
  • Phone: 228-864-3514
  • Fax: 228-864-2402
Mailing address:
  • Phone: 228-864-3514
  • Fax: 228-864-2402

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberE010072
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: