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General NPI Number Information
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NPI Number | 1932204880
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Entity Type | Organization
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Legal Business Name | VAN DEV ENTERPRISES INC
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Dates
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Enumeration Date | 09/14/2006
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Last Update Date | 02/25/2010
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Provider Practice Location Address
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Address Line | 1005 MARKET ST
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City | PORT GIBSON
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State | MS
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Zip | 39150-2337
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Country | US
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Telephone | 601-437-5121
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Fax | 601-437-5102
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Provider Business Mailing Address
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Address Line | PO BOX 1024
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City | PORT GIBSON
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State | MS
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Zip | 39150-1024
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Country | US
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Telephone | 601-437-5121
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Fax | 601-437-5102
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Authorized Official
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Title or Position | OWNER
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Name | DAPHYNE VANDEVENDER
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Credential | PD
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Telephone | 601-437-5121
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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 | 00680
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License Number State | MS
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