MEDICARE: UNIVERSITY OF MISSISSIPPI

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	333600000X	Pharmacy	0222902SU	MS

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2517083	OTHER	MS	NABP

General Provider Information

NPI Number	:	1639277957
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	UNIVERSITY OF MISSISSIPPI

Provider Business Mailing Address
First Line	:	153 REBEL DRIVE
Second Line	:	HARRISON BLDG
City	:	UNIVERSITY
State	:	MS
Zip	:	38677-1848
Country	:	US
Telephone Number	:	662-915-5279
Fax Number	:	662-915-5292

Provider Business Practice Location Address
First Line	:	153 REBEL DRIVE
Second Line	:	HARRISON BLDG
City	:	UNIVERSITY
State	:	MS
Zip	:	38677-1848
Country	:	US
Telephone Number	:	662-915-5279
Fax Number	:	662-915-5292

Authorized Official
Title or Position	:	DIRECTOR OF PHARMACY
Name	:	DR. SANDRA IRENE BENTLEY
Credential	:	PHARMD
Telephone Number	:	662-915-5279

Provider Enumeration Date	:	09/20/2006
Last Update Date	:	03/07/2023

Similar Medicare Providers

1578624649 — MR. TONY F. BARNETT JR. ATC
Practice Location Address:

118 FIELD HOUSE , ALL-AMERICAN DRIVE
UNIVERSITY, MS
38677-1848

Practice Phone: 662-915-7536
Practice Fax: 662-915-5275

1437356805 — MISS ROSALIE GARNER M.S., CCC-SLP
Practice Location Address:

100 GEORGE HALL REBEL DRIVE
UNIVERSITY, MS
38677-1848

Practice Phone: 662-915-7271
Practice Fax: 662-915-5717

1336463298 — MS. VICKI CLARK MAHAN
Practice Location Address:

ALL AMERICAN DRIVE
UNIVERSITY, MS
38677-1848

Practice Phone: 662-915-3789
Practice Fax: 662-915-7831

1871817494 — AMY KILLEN FISHER LCSW
Practice Location Address:

ALL AMERICAN DRIVE , UNIVERSITY COUNSELING CENTER
UNIVERSITY, MS
38677-1848

Practice Phone: 662-915-3784
Practice Fax: 662-915-7831

1477878007 — SUSANNAH FURR LPC
Practice Location Address:

ALL AMERICAN DRIVE , UNIVERSITY COUNSELING CENTER
UNIVERSITY, MS
38677-1848

Practice Phone: 662-915-3788
Practice Fax:

1578875548 — MR. JOSHUA WILLIAM PORTER M.S., L.A.T., A.T.C.
Practice Location Address:

1810 MANNING WAY
UNIVERSITY, MS
38677-1848

Practice Phone: 662-915-7536
Practice Fax: 662-915-5275

Directions to “UNIVERSITY OF MISSISSIPPI ” Practice Location

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