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General NPI Number Information
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NPI Number | 1568513711
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Entity Type | Organization
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Legal Business Name | PROFESSIONAL PHARMACY, INC.
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Dates
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Enumeration Date | 01/15/2007
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Last Update Date | 06/30/2010
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Provider Practice Location Address
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Address Line | 201 HOSPITAL DR
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City | TYLERTOWN
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State | MS
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Zip | 39667-2019
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Country | US
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Telephone | 601-876-2487
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Fax | 601-876-0222
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Provider Business Mailing Address
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Address Line | 201 HOSPITAL DR
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City | TYLERTOWN
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State | MS
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Zip | 39667-2019
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Country | US
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Telephone | 601-876-2487
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Fax | 601-876-0222
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Authorized Official
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Title or Position | PRESIDENT
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Name | MS. KAREN SMITH
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Credential | R.PH
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Telephone | 601-876-2487
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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 | 02151 01.1
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License Number State | MS
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