Amy Abernethy
Individual provider Active NPI Pharmacist · Tupelo, MS
NPI 1265070841 · NPPES record last updated Dec 14, 2019
Key facts
- NPI
- 1265070841
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pharmacist 183500000X
- License
- E08204 (MS)
- Practice address
- 960 W Main St
Tupelo, MS 38801-3538 - Phone
- (662) 840-8559
- NPI assigned
- Dec 14, 2019
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|
| E08204 | MS | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Kroger Limited Partnership I | Current |
Accepting new patients | |
| Kroger Limited Partnership I | Past |
Accepting new patients |
Locations
960 W Main St
Tupelo, MS 38801
Phone (662) 840-8559
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | E08204 | MS | Yes |
Addresses
Primary practice location
960 W Main St
Tupelo, MS 38801-3538
Mailing address
5475 Lake Villa Dr
Tupelo, MS 38801-5819
Other providers in Tupelo, MS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 14, 2019. 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.