Healthcare Provider Details

I. General information

NPI: 1861089435
Provider Name (Legal Business Name): MEREDITH HEGI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/29/2020
Last Update Date: 12/30/2020
Certification Date: 12/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

159 FOUNTAINS BLVD STE B
MADISON MS
39110-6344
US

IV. Provider business mailing address

159 FOUNTAINS BLVD STE B
MADISON MS
39110-6344
US

V. Phone/Fax

Practice location:
  • Phone: 769-231-1400
  • Fax: 769-231-1401
Mailing address:
  • Phone: 769-231-1400
  • Fax: 769-231-1401

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberE-010522
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: