Healthcare Provider Details

I. General information

NPI: 1770660201
Provider Name (Legal Business Name): CONTROLEX ENTERPRISES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 06/04/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 WASHINGTON AVE
OCEAN SPRINGS MS
39564-4637
US

IV. Provider business mailing address

1420 INGALLS AVE
PASCAGOULA MS
39567-5650
US

V. Phone/Fax

Practice location:
  • Phone: 228-875-4272
  • Fax: 228-875-2651
Mailing address:
  • Phone: 228-875-4272
  • Fax: 228-875-2651

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number07128/01.2
License Number StateMS

VIII. Authorized Official

Name: MS. MODENA S CANNON
Title or Position: PHARMACY OPERATIONS MANAGER
Credential:
Phone: 228-769-7067