MEDICARE: JONATHAN GLEN HUBANKS 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-09835	MS

General Provider Information

NPI Number	:	1962929331
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JONATHAN GLEN HUBANKS PHARMD

Provider Business Mailing Address
First Line	:	202 CLINTON BLVD
Second Line	:
City	:	CLINTON
State	:	MS
Zip	:	39056-5126
Country	:	US
Telephone Number	:	601-924-3232
Fax Number	:	601-924-2417

Provider Business Practice Location Address
First Line	:	202 CLINTON BLVD
Second Line	:
City	:	CLINTON
State	:	MS
Zip	:	39056-5126
Country	:	US
Telephone Number	:	601-924-3232
Fax Number	:	601-924-2417

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

Provider Enumeration Date	:	08/27/2017
Last Update Date	:	07/21/2022

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