MEDICARE: MR. MARCUS COURTLAND DEAN PHARMD

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-010819	MS

General Provider Information

NPI Number	:	1679052906
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MARCUS COURTLAND DEAN PHARMD

Provider Business Mailing Address
First Line	:	998 N HALSTEAD RD STE A
Second Line	:
City	:	OCEAN SPRINGS
State	:	MS
Zip	:	39564-3109
Country	:	US
Telephone Number	:	228-215-1911
Fax Number	:	228-215-1906

Provider Business Practice Location Address
First Line	:	3721 CABILDO PL
Second Line	:
City	:	OCEAN SPRINGS
State	:	MS
Zip	:	39564-3727
Country	:	US
Telephone Number	:	228-355-3963
Fax Number	:

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

Provider Enumeration Date	:	08/08/2018
Last Update Date	:	08/08/2018

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