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General NPI Number Information
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NPI Number | 1295711281
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Entity Type | Organization
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Legal Business Name | NORTH MS. MEDICAL CENTER OUTPATIENT PHARMACY
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Dates
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Enumeration Date | 12/21/2005
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 609 GARFIELD ST SUITE A
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City | TUPELO
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State | MS
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Zip | 38801-6337
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Country | US
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Telephone | 662-377-5749
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Fax | 662-377-3685
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Provider Business Mailing Address
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Address Line | 609 GARFIELD ST
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City | TUPELO
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State | MS
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Zip | 38801-6337
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Country | US
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Telephone | 662-377-5749
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Fax | 662-377-3685
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Authorized Official
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Title or Position | PHARMACIST
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Name | MR. CHARLES (CHUCK) TERRELL GHOLSON
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Credential | RPH
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Telephone | 662-377-5749
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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 | 02700/02.0
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License Number State | MS
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