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General NPI Number Information
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NPI Number | 1023549060
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Entity Type | Organization
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Legal Business Name | BRENTWOOD ACQUISITION PHARMACY
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Dates
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Enumeration Date | 03/22/2017
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Last Update Date | 03/11/2019
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Provider Practice Location Address
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Address Line | 3531 LAKELAND DR
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City | FLOWOOD
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State | MS
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Zip | 39232-8049
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Country | US
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Telephone | 601-936-7845
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Fax | 601-936-7846
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Provider Business Mailing Address
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Address Line | 3531 LAKELAND DR
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City | FLOWOOD
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State | MS
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Zip | 39232-8049
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Country | US
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Telephone | 601-936-7845
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Fax | 601-936-7846
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Authorized Official
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Title or Position | DIRECTOR OF PHARMACY
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Name | SAMANTHA MEDINA
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Credential | PHARM.D
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Telephone | 601-936-7845
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336I0012X
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Taxonomy Name | Institutional Pharmacy
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License Number | 05066/3.1
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License Number State | MS
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