Healthcare Provider Details

I. General information

NPI: 1407138118
Provider Name (Legal Business Name): TRITIA MARGALIZITA TOWNSEND PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2011
Last Update Date: 09/20/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6958 GOODMAN RD
OLIVE BRANCH MS
38654-7034
US

IV. Provider business mailing address

9283 S FAIRMONT CIR
COLLIERVILLE TN
38017-3582
US

V. Phone/Fax

Practice location:
  • Phone: 662-890-5047
  • Fax:
Mailing address:
  • Phone: 901-737-0846
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number13268
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberT-010181
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: