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General NPI Number Information
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NPI Number | 1275677890
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Entity Type | Organization
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Legal Business Name | STATE OF MISSISSIPPI UNIVERSITY OF MISSISSIPPI MEDICAL CENTER
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Dates
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Enumeration Date | 02/16/2007
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Last Update Date | 12/19/2012
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Provider Practice Location Address
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Address Line | 350 W WOODROW WILSON AVE 501
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City | JACKSON
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State | MS
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Zip | 39213-7681
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Country | US
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Telephone | 601-815-3857
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Fax | 601-815-8901
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Provider Business Mailing Address
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Address Line | 350 W WOODROW WILSON AVE 501
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City | JACKSON
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State | MS
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Zip | 39213-7681
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Country | US
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Telephone | 601-815-3857
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Fax | 601-815-8901
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Authorized Official
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Title or Position | PHARMACY SUPERVISOR
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Name | STEVEN V DANCER
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Credential | R.PH.
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Telephone | 601-815-8902
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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 | 06430
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License Number State | MS
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