Healthcare Provider Details

I. General information

NPI: 1316037237
Provider Name (Legal Business Name): TUNICA PHARMACY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/13/2006
Last Update Date: 10/16/2023
Certification Date: 10/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1337 HIGHWAY 61 N
TUNICA MS
38676-9661
US

IV. Provider business mailing address

PO BOX 1724
TUNICA MS
38676-1724
US

V. Phone/Fax

Practice location:
  • Phone: 662-363-1431
  • Fax: 662-363-9966
Mailing address:
  • Phone: 662-363-1431
  • Fax: 663-363-9966

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number00653
License Number StateMS

VIII. Authorized Official

Name: WILLIAM ERIC POFF
Title or Position: OWNER PRESIDENT
Credential: R.PH.
Phone: 901-826-6493