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General NPI Number Information
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NPI Number | 1295703536
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Entity Type | Organization
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Legal Business Name | FUNDERBURKS PHARMACY INC
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Dates
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Enumeration Date | 03/11/2006
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Last Update Date | 03/24/2023
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Provider Practice Location Address
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Address Line | 134 W COMMERCE ST
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City | HERNANDO
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State | MS
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Zip | 38632-2240
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Country | US
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Telephone | 662-429-5337
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Fax |
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Provider Business Mailing Address
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Address Line | 134 W COMMERCE ST
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City | HERNANDO
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State | MS
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Zip | 38632-2240
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Country | US
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Telephone | 662-429-5337
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MRS. CHERYL M SUDDUTH
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Credential | R.PH.
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Telephone | 662-429-5337
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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 | 00908/01.1
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License Number State | MS
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