Healthcare Provider Details

I. General information

NPI: 1356406490
Provider Name (Legal Business Name): D AND L MED LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/27/2006
Last Update Date: 10/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5315 OLD HIGHWAY 11 SUITE 4
HATTIESBURG MS
39402-6224
US

IV. Provider business mailing address

PO BOX 9830
SALT LAKE CITY UT
84109-9830
US

V. Phone/Fax

Practice location:
  • Phone: 601-271-2006
  • Fax: 800-716-4177
Mailing address:
  • Phone: 877-540-4748
  • Fax: 801-716-4872

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number07214/2.3
License Number StateMS

VIII. Authorized Official

Name: DANNY MYERS
Title or Position: OWNER
Credential: RPH
Phone: 601-408-6250