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Provider Information for 1417794918


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NORTHTOWN PHARMACY LLC

Organization Subpart: NO

NPI: 1417794918
Last Updated: 2024-07-11
Certification Date: 2024-07-11

Details

NameValue
NPI1417794918
Enumeration Date2024-07-11
NPI TypeNPI-2 Organization
StatusActive
Authorized Official Information Name: Dr. ANDREW CLARK PharmD
Title: Pharmacist and Owner
Phone: 6016654694
Mailing Address 6220 OLD CANTON RD
JACKSON, MS 39211-2924
United States

Phone: 601-665-4694 | Fax:769-333-9173
 
Primary Practice Address 6220 OLD CANTON RD
JACKSON, MS 39211-2924
United States

Phone: 601-665-4694 | Fax:769-333-9173
 
Secondary Practice Address(es)
Health Information Exchange
Endpoint TypeEndpointEndpoint DescriptionUseContent TypeAffiliationEndpoint Location
Other Identifiers
IssuerStateNumberOther Issuer
Taxonomy
Primary TaxonomySelected TaxonomyStateLicense Number
Yes 3336C0003X - Pharmacy - Community/Retail Pharmacy