Healthcare Provider Details

I. General information

NPI: 1295091023
Provider Name (Legal Business Name): OXFORD FAMILY PHARMACY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/05/2012
Last Update Date: 04/25/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2209 S LAMAR BLVD
OXFORD MS
38655-5225
US

IV. Provider business mailing address

2209 S LAMAR BLVD
OXFORD MS
38655-5225
US

V. Phone/Fax

Practice location:
  • Phone: 662-234-6315
  • Fax: 662-513-4078
Mailing address:
  • Phone: 662-234-6315
  • Fax: 662-513-4078

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number00269
License Number StateMS

VIII. Authorized Official

Name: MICHAEL BASKERVILLE
Title or Position: PHARMACIST
Credential:
Phone: 662-234-6315