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General NPI Number Information
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NPI Number | 1578955381
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Entity Type | Organization
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Legal Business Name | UPTOWN PHARMACY
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Dates
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Enumeration Date | 03/03/2015
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Last Update Date | 03/12/2015
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Provider Practice Location Address
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Address Line | 1042 GLUCKSTADT RD SUITE D
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City | MADISON
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State | MS
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Zip | 39110-6981
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Country | US
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Telephone | 601-631-1667
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Fax |
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Provider Business Mailing Address
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Address Line | 119 PLANTERS ROW
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City | MADISON
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State | MS
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Zip | 39110-7990
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Country | US
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Telephone | 601-631-1667
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Fax |
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Authorized Official
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Title or Position | PHARMACIST
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Name | DR. JIMMY D YAWN II
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Credential | PHARMD
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Telephone | 601-631-1667
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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 | 14250
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License Number State | MS
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