Organization Name: | MS STATE DEPT OF HEALTH PHARMACY |
NPI Number: | 1457505315 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | TRAVIS L REEVES (ASST DIRECTOR) |
Mailing Address: | 3156 Lawson St Jackson |
State: | MS US |
Postal Code: | 392135754 |
Phone Number: | 6017133457 |
Fax Number: | 6013642670 |
NPI Enumeration Date: | 11/05/2008 |
NPI Last Update Date: | 11/05/2008 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 251K00000X |
License Number: | 01085 05.1 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MS |
Taxonomy Type: | Agencies |
Taxonomy Classification: | Public Health or Welfare |
Taxonomy Specialization: | |
Taxonomy Definition: |