Healthcare Provider Details

I. General information

NPI: 1275744567
Provider Name (Legal Business Name): P.E.B. INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/25/2007
Last Update Date: 06/23/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1121 OCEAN SPRINGS RD
OCEAN SPRINGS MS
39564-3421
US

IV. Provider business mailing address

1121 OCEAN SPRINGS RD
OCEAN SPRINGS MS
39564-3421
US

V. Phone/Fax

Practice location:
  • Phone: 228-875-0158
  • Fax: 228-875-4546
Mailing address:
  • Phone: 228-875-0158
  • Fax: 228-875-4546

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: BURT L. PATTERSON
Title or Position: PRESIDENT / PHARMACIST
Credential: RPH
Phone: 228-875-0158