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General NPI Number Information
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NPI Number | 1689738742
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Entity Type | Organization
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Legal Business Name | PICAYUNE MEDICAL & HEALTH SUPPLIES INC
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Dates
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Enumeration Date | 12/21/2006
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Last Update Date | 03/23/2011
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Provider Practice Location Address
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Address Line | 141 KIRKWOOD ST
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City | PICAYUNE
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State | MS
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Zip | 39466-3833
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Country | US
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Telephone | 601-798-2100
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Fax | 601-798-5730
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Provider Business Mailing Address
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Address Line | 141 KIRKWOOD ST
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City | PICAYUNE
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State | MS
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Zip | 39466-3833
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Country | US
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Telephone | 601-798-2100
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Fax | 601-798-5730
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. ALAN KEITH DOSSETT
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Credential | RPH
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Telephone | 601-798-2100
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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 | 0036701.1
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License Number State | MS
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