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General NPI Number Information
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NPI Number | 1659503878
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Entity Type | Organization
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Legal Business Name | BATTLEFIELD COMPOUNDING CENTER INCORPORATED
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Dates
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Enumeration Date | 08/21/2009
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Last Update Date | 11/03/2009
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Provider Practice Location Address
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Address Line | 2080 S FRONTAGE RD SUITE 101A
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City | VICKSBURG
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State | MS
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Zip | 39180-5328
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Country | US
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Telephone | 601-636-6693
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Fax | 601-638-8446
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Provider Business Mailing Address
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Address Line | 120 STENSON RD
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City | VICKSBURG
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State | MS
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Zip | 39180-8860
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | JOHN STOREY
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Credential |
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Telephone | 601-642-7050
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0004X
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Taxonomy Name | Compounding Pharmacy
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License Number | 08210/02.2
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License Number State | MS
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