Healthcare Provider Details

I. General information

NPI: 1407343023
Provider Name (Legal Business Name): DOWELLS PHARMACY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/19/2018
Last Update Date: 03/22/2022
Certification Date: 03/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

124 E BAKER ST
INDIANOLA MS
38751-2451
US

IV. Provider business mailing address

124 E BAKER ST
INDIANOLA MS
38751-2451
US

V. Phone/Fax

Practice location:
  • Phone: 662-931-1900
  • Fax:
Mailing address:
  • Phone: 662-887-4533
  • Fax: 662-887-4572

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MATTHEW GEORGE DOWELL
Title or Position: MANAGER
Credential: PHARMD
Phone: 662-887-4533