MEDICARE: PEYTEN, LTD.

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	E7245	MS

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1093701526
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PEYTEN, LTD.

Provider Business Mailing Address
First Line	:	1883 HIGHWAY 43 S
Second Line	:	SUITE A
City	:	CANTON
State	:	MS
Zip	:	39046-8405
Country	:	US
Telephone Number	:	601-407-1440
Fax Number	:	601-407-1441

Provider Business Practice Location Address
First Line	:	1883 HIGHWAY 43 S
Second Line	:	SUITE A
City	:	CANTON
State	:	MS
Zip	:	39046-8405
Country	:	US
Telephone Number	:	601-407-1440
Fax Number	:	601-407-1441

Authorized Official
Title or Position	:	OWNER/PHARMACIST
Name	:	DR. JULIA C TENNIN
Credential	:	PHARM D
Telephone Number	:	601-407-1440

Provider Enumeration Date	:	09/20/2005
Last Update Date	:	08/22/2020

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Directions to “PEYTEN, LTD. ” Practice Location

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