=====================================================
General NPI Number Information
=====================================================
NPI Number | 1457255762
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MOHAMED MARZOUK
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/08/2026
-----------------------------------------------------
Last Update Date | 10/08/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2202 HIGHWAY 82 W
-----------------------------------------------------
City | GREENWOOD
-----------------------------------------------------
State | MS
-----------------------------------------------------
Zip | 38930-2706
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 662-453-3967
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 218 KAREN DR
-----------------------------------------------------
City | OXFORD
-----------------------------------------------------
State | MS
-----------------------------------------------------
Zip | 38655-7077
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 662-202-8544
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | E-102628
-----------------------------------------------------
License Number State | MS
-----------------------------------------------------