Healthcare Provider Details

I. General information

NPI: 1942336888
Provider Name (Legal Business Name): WAYNE POWELL R.PH.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/26/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1245 HWY 19 SOUTH
MERIDIAN MS
39301
US

IV. Provider business mailing address

PO BOX 138
MARION MS
39342-0138
US

V. Phone/Fax

Practice location:
  • Phone: 601-938-9700
  • Fax: 601-485-8247
Mailing address:
  • Phone: 601-938-9700
  • Fax: 601-485-8247

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835G0303X
TaxonomyGeriatric Pharmacist
License NumberE-8227
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: