Healthcare Provider Details

I. General information

NPI: 1831645373
Provider Name (Legal Business Name): THE PHARMACY OF MARKS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/25/2016
Last Update Date: 08/25/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1039 MARTIN LUTHER KING DR
MARKS MS
38646-1808
US

IV. Provider business mailing address

PO BOX 5105
MERIDIAN MS
39302-5105
US

V. Phone/Fax

Practice location:
  • Phone: 662-326-8609
  • Fax:
Mailing address:
  • Phone: 601-693-2655
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number06997/1.1
License Number StateMS

VIII. Authorized Official

Name: DAVID MAJURE
Title or Position: OWNER
Credential:
Phone: 601-693-2655