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General NPI Number Information
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NPI Number | 1093883233
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Entity Type | Organization
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Legal Business Name | MEDI CENTER PHARMACY
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Dates
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Enumeration Date | 12/04/2006
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Last Update Date | 08/13/2007
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Provider Practice Location Address
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Address Line | 1629 N STATE ST
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City | CLARKSDALE
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State | MS
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Zip | 38614-6617
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Country | US
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Telephone | 662-624-6561
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Fax | 662-627-2845
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Provider Business Mailing Address
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Address Line | 1629 N STATE ST
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City | CLARKSDALE
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State | MS
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Zip | 38614-6617
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Country | US
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Telephone | 662-624-6561
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Fax | 662-624-6562
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Authorized Official
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Title or Position | OWNER
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Name | AUDRIC CHOW
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Credential | PHRM
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Telephone | 662-624-6561
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number | 01632011
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License Number State | MS
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Taxonomy #2
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number |
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License Number State |
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