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General NPI Number Information
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NPI Number | 1740954213
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Entity Type | Individual
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Provider Name | NICOLE DEPEW
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Gender | Female
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Dates
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Enumeration Date | 08/06/2021
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Last Update Date | 08/06/2021
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Provider Practice Location Address
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Address Line | 120 W RAILROAD ST
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City | LONG BEACH
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State | MS
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Zip | 39560-4634
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Country | US
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Telephone | 228-575-4057
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Fax |
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Provider Business Mailing Address
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Address Line | 1596 BIRKSHIRE CT
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City | BILOXI
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State | MS
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Zip | 39532-2254
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Country | US
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Telephone | 954-656-7183
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | E-100319
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License Number State | MS
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