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General NPI Number Information
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NPI Number | 1679985378
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Entity Type | Organization
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Legal Business Name | CALEB'S HOMETOWN PHARMACY
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Dates
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Enumeration Date | 05/29/2014
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Last Update Date | 10/01/2024
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Provider Practice Location Address
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Address Line | 801 MAIN STREET
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City | COLLINS
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State | MS
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Zip | 39428
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Country | US
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Telephone | 601-765-5055
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Fax | 601-765-8544
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Provider Business Mailing Address
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Address Line | PO BOX 2396
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City | COLLINS
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State | MS
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Zip | 39428-2396
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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 | OWNER/PHARMACIST
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Name | STEPHEN CALEB WILLIAMSON
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Credential | PHARM.D.
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Telephone | 601-765-5055
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 13446
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License Number State | MS
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