Provider Information for 1417794918
The following NPI(s) contain information matching your search criteria. Please select the NPI to view all the data associated with the NPI.
Please Note: Issuance of an NPI does not ensure or validate that the Health Care Provider is Licensed or Credentialed. For more information please refer to NPI: What You Need to Know
NORTHTOWN PHARMACY LLC
Organization Subpart: NO
NPI: 1417794918
Last Updated: 2024-07-11
Certification Date: 2024-07-11
Certification Date: 2024-07-11
Details
Name | Value | ||||||||
---|---|---|---|---|---|---|---|---|---|
NPI | 1417794918 | ||||||||
Enumeration Date | 2024-07-11 | ||||||||
NPI Type | NPI-2 Organization | ||||||||
Status | Active | ||||||||
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 |
| ||||||||
Other Identifiers |
| ||||||||
Taxonomy |
|