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General NPI Number Information
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NPI Number | 1265148209
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Entity Type | Organization
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Legal Business Name | MARKETPLACE PHARMACY GROUP LLC
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Dates
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Enumeration Date | 01/24/2023
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Last Update Date | 01/24/2023
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Provider Practice Location Address
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Address Line | 157 SHELBY SPEIGHTS DR
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City | PURVIS
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State | MS
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Zip | 39475-4094
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Country | US
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Telephone | 601-794-8634
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1005
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City | PURVIS
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State | MS
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Zip | 39475-1005
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Country | US
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Telephone | 601-794-8634
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Fax |
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Authorized Official
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Title or Position | PHARMACIST-IN-CHARGE
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Name | DR. AMY LINDSEY VIVIEN
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Credential | PHARMD
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Telephone | 601-436-7969
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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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