Healthcare Provider Details

I. General information

NPI: 1538686795
Provider Name (Legal Business Name): JAMES ANDREW CHEATHAM RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/28/2017
Last Update Date: 08/28/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20917 HIGHWAY 61
ROLLING FORK MS
39159-5027
US

IV. Provider business mailing address

20917 HIGHWAY 61
ROLLING FORK MS
39159-5027
US

V. Phone/Fax

Practice location:
  • Phone: 662-873-4723
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberE-5696
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: