Edwin Walter Amelung Jr.
Individual provider Active NPI Pharmacist · Cleveland, MS
NPI 1013225564 · NPPES record last updated Sep 17, 2010
Key facts
- NPI
- 1013225564
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pharmacist 183500000X
- License
- E-7374 (MS)
- Practice address
- 306 E Sunflower Rd
Cleveland, MS 38732-2732 - Phone
- (662) 843-9800
- NPI assigned
- Sep 17, 2010
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| E-7374 | MS | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Freds Stores of Tennessee Inc | Past | Accepting new patients | |
| Freds Stores of Tennessee Inc | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | E-7374 | MS | Yes |
Addresses
Primary practice location
306 E Sunflower Rd
Cleveland, MS 38732-2732
Mailing address
307 W Jefferson Ave
Greenwood, MS 38930-3407
Phone (662) 453-6685
Other providers in Cleveland, MS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 17, 2010. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.