Alex Ambeau, PHARMD

Individual provider Active NPI Pharmacist · Hattiesburg, MS

NPI 1023316163 · NPPES record last updated Mar 12, 2011

Key facts

NPI
1023316163
Entity type
Individual (NPI type 1)
Primary specialty
Pharmacist 183500000X
License
E-010452 (MS)
Practice address
4400 Hardy St
Hattiesburg, MS 39402-1372
Phone
(601) 268-9681
NPI assigned
Mar 12, 2011
Sex
Male
Sole proprietor
No

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
No
Credentials
Doctor of Pharmacy

State licenses

LicenseStateTypeSpecialty
E-010452MSMDPharmacist

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacist 183500000X E-010452 MS Yes

Addresses

Primary practice location

4400 Hardy St
Hattiesburg, MS 39402-1372

Mailing address

4400 Hardy St
Hattiesburg, MS 39402-1372
Phone (601) 268-9681

Other providers in Hattiesburg, MS

All providers in Hattiesburg, MS · Pharmacist in Mississippi

Sources for this page

Verify at the official NPI Registry.