Healthcare Provider Details

I. General information

NPI: 1346234184
Provider Name (Legal Business Name): HUDSPETH CENTER PHARMACY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/08/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

HIGHWAY 475
WHITFIELD MS
39193
US

IV. Provider business mailing address

PO BOX 127B
WHITFIELD MS
39193-1032
US

V. Phone/Fax

Practice location:
  • Phone: 601-664-6352
  • Fax:
Mailing address:
  • Phone: 601-664-6352
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code315P00000X
TaxonomyIntellectual Disabilities Intermediate Care Facility
License Number01343/03.1
License Number StateMS

VIII. Authorized Official

Name: DR. JOHN LIPSCOMB
Title or Position: DIRECTOR OF HUDSPETH REGIONAL CENTE
Credential:
Phone: 601-664-6010