MEDICARE: DR. MARY MARGARET VIA PHARM.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	E-14396	MS

General Provider Information

NPI Number	:	1073966149
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARY MARGARET VIA PHARM.D.

Provider Business Mailing Address
First Line	:	738 S GLOSTER ST
Second Line	:
City	:	TUPELO
State	:	MS
Zip	:	38801-4932
Country	:	US
Telephone Number	:	662-844-0432
Fax Number	:

Provider Business Practice Location Address
First Line	:	738 S GLOSTER ST
Second Line	:
City	:	TUPELO
State	:	MS
Zip	:	38801-4932
Country	:	US
Telephone Number	:	662-844-0432
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/13/2016
Last Update Date	:	07/13/2016

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