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General NPI Number Information
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NPI Number | 1336416973
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Entity Type | Organization
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Legal Business Name | DOWNTOWN PHARMACY
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Dates
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Enumeration Date | 11/28/2011
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Last Update Date | 02/14/2017
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Provider Practice Location Address
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Address Line | 511 W LAUREL AVE
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City | HATTIESBURG
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State | MS
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Zip | 39401-3504
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Country | US
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Telephone | 601-544-7111
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Fax | 601-544-7154
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Provider Business Mailing Address
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Address Line | 511 W LAUREL AVE
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City | HATTIESBURG
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State | MS
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Zip | 39401-3504
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Country | US
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Telephone | 601-544-7111
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Fax | 601-544-7154
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Authorized Official
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Title or Position | PHARMACIST
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Name | CHARLENE HERNANDEZ
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Credential |
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Telephone | 601-544-7111
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 09182/1.1
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License Number State | MS
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