Healthcare Provider Details

I. General information

NPI: 1982977609
Provider Name (Legal Business Name): MACKIE P GREENLEE BS PHARMACY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/10/2012
Last Update Date: 02/10/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2266 HIGHWAY 407
KILMICHAEL MS
39747-9609
US

IV. Provider business mailing address

2266 HIGHWAY 407
KILMICHAEL MS
39747-9609
US

V. Phone/Fax

Practice location:
  • Phone: 662-262-7949
  • Fax:
Mailing address:
  • Phone: 662-262-7949
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberE-06184
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: