Organization Name: | HORN LAKE FAMILY PRACTICE |
NPI Number: | 1356718233 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | SHEETAL SHARMA (MEMBER) |
Mailing Address: | 3102 Goodman Rd W Horn Lake |
State: | MS US |
Postal Code: | 386371172 |
Phone Number: | 6623426677 |
Fax Number: | 6623420203 |
NPI Enumeration Date: | 08/27/2015 |
NPI Last Update Date: | 02/18/2016 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 3336C0004X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | |
Taxonomy Type: | Suppliers |
Taxonomy Classification: | Pharmacy |
Taxonomy Specialization: | Compounding Pharmacy |
Taxonomy Definition: | A pharmacy that specializes in the preparation of components into a drug preparation as the result of a Practitioner |