Active NPI
Terry L Mix, DPH
- Pharmacist
- Southaven, MS
National Provider Identifier
1346842523
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 6753
- Practice address
- 2996 Church Rd E
Southaven, MS 38671-9825 - Phone
- (662) 949-4418
- NPI assigned
- Nov 12, 2020
- Last updated
- Nov 12, 2020
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 6753 | MS | Primary |
Addresses
Primary practice location
2996 Church Rd E
Southaven, MS 38671-9825
Mailing address
2996 Church Rd E
Southaven, MS 38671-9825
Phone (662) 349-4418
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| CONNECT URL | Southaven | Direct |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6753 | MS | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Walgreen Co | Current | Accepting new patients | |
| Walgreen Co | Past | Accepting new patients |
Locations
2996 Church Rd E
Southaven, MS 38671
Phone (662) 349-4418
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1605139200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1605139200000",
"number": "1346842523",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2996 CHURCH RD E",
"city": "SOUTHAVEN",
"state": "MS",
"postal_code": "386719825",
"telephone_number": "662-349-4418"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2996 CHURCH RD E",
"city": "SOUTHAVEN",
"state": "MS",
"postal_code": "386719825",
"telephone_number": "662-949-4418"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MIX",
"first_name": "TERRY",
"middle_name": "L",
"name_prefix": "Mr.",
"credential": "DPH",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2020-11-12",
"last_updated": "2020-11-12",
"certification_date": "2020-11-12",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "MS",
"license": "6753",
"primary": true
}
],
"identifiers": [],
"endpoints": [
{
"endpointType": "CONNECT",
"endpointTypeDescription": "CONNECT URL",
"endpoint": "Southaven",
"affiliation": "N",
"use": "DIRECT",
"useDescription": "Direct",
"contentType": "OTHER",
"contentTypeDescription": "Other",
"contentOtherDescription": "Southaven",
"address_1": "2996 Church Rd E",
"city": "Southaven",
"state": "MS",
"country_code": "US",
"postal_code": "386719825",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Southaven, MS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 12, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.