Healthcare Provider Details

I. General information

NPI: 1487695813
Provider Name (Legal Business Name): FAMILY HEALTH CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/09/2006
Last Update Date: 09/28/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

117 S 11TH AVE
LAUREL MS
39440-4312
US

IV. Provider business mailing address

PO BOX 4361
LAUREL MS
39441-4361
US

V. Phone/Fax

Practice location:
  • Phone: 601-425-3033
  • Fax: 601-422-0727
Mailing address:
  • Phone: 601-425-3033
  • Fax: 601-422-0727

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0002X
TaxonomyClinic Pharmacy
License Number04873
License Number StateMS

VIII. Authorized Official

Name: RONALD HENRY
Title or Position: PHARMACY DIR
Credential:
Phone: 601-425-3033