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General NPI Number Information
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NPI Number | 1396259966
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Entity Type | Organization
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Legal Business Name | SHILOH APOTHECARY INC
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Dates
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Enumeration Date | 11/19/2017
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Last Update Date | 01/09/2024
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Provider Practice Location Address
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Address Line | 2049 E SHILOH RD
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City | CORINTH
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State | MS
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Zip | 38834-3726
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Country | US
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Telephone | 662-594-1573
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Fax | 662-594-1628
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Provider Business Mailing Address
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Address Line | 2049 E SHILOH RD
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City | CORINTH
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State | MS
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Zip | 38834-3726
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Country | US
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Telephone | 662-594-1573
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Fax | 662-594-1628
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Authorized Official
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Title or Position | PRESIDENT/OWNER
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Name | RAYMOND LAFAYETTE MATHIS
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Credential | PHARM.D.
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Telephone | 662-594-1573
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0004X
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Taxonomy Name | Compounding 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 | 16600
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License Number State | MS
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