MEDICARE: KRISTI MCCLUSKEY 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-09926	MS

General Provider Information

NPI Number	:	1851997597
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTI MCCLUSKEY PHARMD

Provider Business Mailing Address
First Line	:	1866 SPILLWAY RD
Second Line	:
City	:	BRANDON
State	:	MS
Zip	:	39047-6063
Country	:	US
Telephone Number	:	601-992-4466
Fax Number	:	601-992-4415

Provider Business Practice Location Address
First Line	:	1866 SPILLWAY RD
Second Line	:
City	:	BRANDON
State	:	MS
Zip	:	39047-6063
Country	:	US
Telephone Number	:	601-992-4466
Fax Number	:	601-992-4415

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

Provider Enumeration Date	:	12/08/2020
Last Update Date	:	12/08/2020

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