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General NPI Number Information
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NPI Number | 1144383613
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Entity Type | Organization
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Legal Business Name | POMANK VENTURES LLC
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Dates
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Enumeration Date | 12/18/2006
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Last Update Date | 06/16/2016
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Provider Practice Location Address
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Address Line | 500 KATIE AVE
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City | HATTIESBURG
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State | MS
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Zip | 39401-4380
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Country | US
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Telephone | 601-544-4871
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Fax | 601-583-2298
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Provider Business Mailing Address
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Address Line | 500 KATIE AVE
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City | HATTIESBURG
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State | MS
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Zip | 39401-4380
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Country | US
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Telephone | 601-544-4871
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Fax | 601-583-2298
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Authorized Official
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Title or Position | R. PH.
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Name | GLADYS BARNETT
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Credential |
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Telephone | 601-544-4871
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3336C0004X
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Taxonomy Name | Compounding Pharmacy
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number | 01066/1.1
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License Number State | MS
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