Healthcare Provider Details

I. General information

NPI: 1952773517
Provider Name (Legal Business Name): WMC PHARMACY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/22/2015
Last Update Date: 10/22/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1938 CRESCENT MEADOWS DR
HOLLY SPRINGS MS
38635-7419
US

IV. Provider business mailing address

1938 CRESCENT MEADOWS DR
HOLLY SPRINGS MS
38635-7419
US

V. Phone/Fax

Practice location:
  • Phone: 662-252-8464
  • Fax: 662-252-1986
Mailing address:
  • Phone: 662-252-8464
  • Fax: 662-252-1986

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number14080
License Number StateMS

VIII. Authorized Official

Name: DR. KENNETH WILLIAMS
Title or Position: PRESIDENT /OWNER
Credential: M.D.
Phone: 662-252-1599