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General NPI Number Information
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NPI Number | 1053922138
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Entity Type | Individual
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Provider Name | JOSHUA FAVRE
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Gender | Male
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Dates
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Enumeration Date | 08/12/2020
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Last Update Date | 08/12/2020
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Provider Practice Location Address
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Address Line | 2405 PASS RD
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City | BILOXI
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State | MS
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Zip | 39531-2111
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Country | US
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Telephone | 228-388-3458
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Fax | 228-388-4091
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Provider Business Mailing Address
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Address Line | 336 SPRINGDALE CIR
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City | DIBERVILLE
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State | MS
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Zip | 39540-3733
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Country | US
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Telephone | 228-209-4699
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | E-15006
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License Number State | MS
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