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General NPI Number Information
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NPI Number | 1295169753
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Entity Type | Organization
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Legal Business Name | 30A INNOVATIONS,LLC
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Dates
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Enumeration Date | 09/02/2013
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Last Update Date | 09/02/2013
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Provider Practice Location Address
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Address Line | 3902 HARDY ST
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City | HATTIESBURG
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State | MS
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Zip | 39402-1541
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Country | US
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Telephone | 601-422-7813
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 16586
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City | HATTIESBURG
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State | MS
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Zip | 39404-6586
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PHARMACIST/CO-OWNER
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Name | MISS MICHELLE SCOGGIN
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Credential |
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Telephone | 601-422-7813
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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 | MS
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