Healthcare Provider Details

I. General information

NPI: 1487924916
Provider Name (Legal Business Name): S. PHILLIP CARSON PHARM D. ; R.PH.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/30/2011
Last Update Date: 12/30/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2801 W MAIN ST
TUPELO MS
38801-3001
US

IV. Provider business mailing address

2801 W MAIN ST
TUPELO MS
38801-3001
US

V. Phone/Fax

Practice location:
  • Phone: 662-840-6411
  • Fax: 662-840-4598
Mailing address:
  • Phone: 662-840-6411
  • Fax: 662-840-4598

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1835N1003X
TaxonomyNutrition Support Pharmacist
License NumberE-7450
License Number StateMS
# 2
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number34541
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: