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General NPI Number Information
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NPI Number | 1992887020
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Entity Type | Organization
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Legal Business Name | CONTROLEX ENTERPRISES, INC.
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Dates
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Enumeration Date | 10/19/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1714 DENNY AVE
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City | PASCAGOULA
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State | MS
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Zip | 39567-3303
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Country | US
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Telephone | 228-762-7192
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Fax |
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Provider Business Mailing Address
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Address Line | 1420 INGALLS AVE
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City | PASCAGOULA
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State | MS
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Zip | 39567-5650
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Country | US
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Telephone | 228-769-7067
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Fax | 228-762-1756
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Authorized Official
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Title or Position | PHARMACY OPERATIONS MANAGER
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Name | MS. MODENA S CANNON
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Credential |
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Telephone | 228-769-7067
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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 | 00842/01.2
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License Number State | MS
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