Healthcare Provider Details

I. General information

NPI: 1225952666
Provider Name (Legal Business Name): SYDNEY MADISON YANCEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/07/2026
Last Update Date: 08/07/2026
Certification Date: 08/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

817 W MAIN ST
TUPELO MS
38801-3630
US

IV. Provider business mailing address

1501 COUNTY ROAD 741
DUMAS MS
38625-9615
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberYANC-OHV0C2
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: