MEDICARE: KELSEY BARNETT MIZE

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-16140	MS

General Provider Information

NPI Number	:	1720690498
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELSEY BARNETT MIZE

Provider Business Mailing Address
First Line	:	4028 GOODMAN RD W
Second Line	:
City	:	HORN LAKE
State	:	MS
Zip	:	38637-1325
Country	:	US
Telephone Number	:	662-393-3477
Fax Number	:	662-393-3214

Provider Business Practice Location Address
First Line	:	4028 GOODMAN RD W
Second Line	:
City	:	HORN LAKE
State	:	MS
Zip	:	38637-1325
Country	:	US
Telephone Number	:	662-393-3477
Fax Number	:	662-393-3214

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

Provider Enumeration Date	:	08/23/2020
Last Update Date	:	08/23/2020

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Directions to “ KELSEY BARNETT MIZE ” Practice Location

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