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General NPI Number Information
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NPI Number | 1497852602
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Entity Type | Organization
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Legal Business Name | MEDICAL PLAZA ON ALCORN LLC
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Dates
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Enumeration Date | 09/20/2006
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Last Update Date | 09/01/2015
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Provider Practice Location Address
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Address Line | 111 ALCORN DR
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City | CORINTH
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State | MS
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Zip | 38834-9359
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Country | US
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Telephone | 662-286-6991
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Fax | 662-287-8087
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Provider Business Mailing Address
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Address Line | 111 ALCORN DR
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City | CORINTH
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State | MS
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Zip | 38834-9359
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Country | US
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Telephone | 662-286-6991
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Fax | 662-287-8087
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Authorized Official
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Title or Position | RPH
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Name | MR. RICK W QUINN
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Credential |
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Telephone | 662-286-6991
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 0313501.1
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License Number State | MS
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