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General NPI Number Information
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NPI Number | 1518505320
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Entity Type | Individual
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Provider Name | DEONTE R POWELL SR. PHARM.D
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Gender | Male
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Dates
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Enumeration Date | 12/12/2019
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Last Update Date | 12/12/2019
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Provider Practice Location Address
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Address Line | 1778 HIGHWAY 1 S
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City | GREENVILLE
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State | MS
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Zip | 38701-7801
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Country | US
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Telephone | 601-218-1544
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Fax | 662-332-0232
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Provider Business Mailing Address
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Address Line | 130 VILLAGE DR
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City | VICKSBURG
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State | MS
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Zip | 39183-2320
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Country | US
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Telephone | 601-218-1544
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | E-14095
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License Number State | MS
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