Healthcare Provider Details

I. General information

NPI: 1922630797
Provider Name (Legal Business Name): FUNDERBURK'S PHARMACY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/10/2020
Last Update Date: 02/10/2020
Certification Date: 02/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

134 W COMMERCE ST
HERNANDO MS
38632-2240
US

IV. Provider business mailing address

134 W COMMERCE ST
HERNANDO MS
38632-2240
US

V. Phone/Fax

Practice location:
  • Phone: 662-429-5337
  • Fax: 662-429-5207
Mailing address:
  • Phone: 662-429-5337
  • Fax: 662-429-5207

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: CHERYL M. SUDDUTH
Title or Position: PHARMACIST/OWNER
Credential:
Phone: 662-429-5337