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General NPI Number Information
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NPI Number | 1114449287
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Entity Type | Organization
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Legal Business Name | FAMILY DRUG MART OF BRANDON, LLC
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Dates
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Enumeration Date | 07/11/2017
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Last Update Date | 12/24/2021
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Provider Practice Location Address
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Address Line | 212 E GOVERNMENT ST
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City | BRANDON
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State | MS
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Zip | 39042-3152
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Country | US
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Telephone | 504-338-7992
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Fax | 985-727-7494
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Provider Business Mailing Address
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Address Line | 2299 SUNSET BLVD
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City | SLIDELL
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State | LA
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Zip | 70461-5605
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Country | US
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Telephone | 504-338-7992
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Fax | 852-654-5509
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Authorized Official
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Title or Position | OWNER/PHARMACIST
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Name | MR. JOSE MIGUEL YANEZ
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Credential |
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Telephone | 504-338-7992
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 16010
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License Number State | MS
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