Hattiesburg Clinic PA
Organization Active NPI Community/Retail Pharmacy · Hattiesburg, MS
NPI 1407861016 · NPPES record last updated Feb 21, 2017
Key facts
- NPI
- 1407861016
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Community/Retail Pharmacy 3336C0003X
- License
- 01821/1.1 (MS)
- Legal business name
- HATTIESBURG CLINIC PA
- Practice address
- Medical Blvd
Ste 2
Hattiesburg, MS 39401 - Phone
- (601) 268-5740
- Fax
- (601) 268-5858
- NPI assigned
- Jul 30, 2006
- Organization subpart
- No
Authorized official
- Name
- Diane Ashley, RPH
- Title
- Phcy Dir
- Phone
- (601) 268-2740
Corporate family (same tax ID) 24
National Provider Directory
- Tax ID family
- Hattiesburg Clinic PA
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacy | 333600000X | |||
| Community/Retail Pharmacy | 3336C0003X | 01821/1.1 | MS | Yes |
| Long Term Care Pharmacy | 3336L0003X |
Addresses
Primary practice location
Medical Blvd
Ste 2
Hattiesburg, MS 39401
Mailing address
Medical Blvd
Ste 2
Hattiesburg, MS 39401
Phone (601) 268-5740
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2045095 | Other | PK | |
| 00030291 | Medicaid | MS |
Other names
- OWL DRUG STORE
Other providers in Hattiesburg, MS
- Hattiesburg Clinic PA
- Hattiesburg Clinic PA
- Hattiesburg Clinic PA
- Hattiesburg Clinic PA
- Hattiesburg Clinic PA
- Hattiesburg Clinic PA
- Hattiesburg Clinic PA
- Hattiesburg Clinic PA
- Hattiesburg Clinic PA
- Hattiesburg Clinic PA
All providers in Hattiesburg, MS · Community/Retail Pharmacy in Mississippi
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 21, 2017. 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.