Healthcare Provider Details

I. General information

NPI: 1144503384
Provider Name (Legal Business Name): MORI FREEZE SYKES RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/23/2011
Last Update Date: 09/23/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

817 W MAIN ST
TUPELO MS
38801-3630
US

IV. Provider business mailing address

817 W MAIN ST
TUPELO MS
38801-3630
US

V. Phone/Fax

Practice location:
  • Phone: 662-620-7959
  • Fax:
Mailing address:
  • Phone: 662-620-7959
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberT09648
License Number StateMS
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number6619
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: