Provider Demographics
NPI:1043738875
Name:INMON, MIKE J (RPH)
Entity Type:Individual
Prefix:MR
First Name:MIKE
Middle Name:J
Last Name:INMON
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:409 DUNCAN ST
Mailing Address - Street 2:
Mailing Address - City:WATER VALLEY
Mailing Address - State:MS
Mailing Address - Zip Code:38965-2547
Mailing Address - Country:US
Mailing Address - Phone:662-473-3333
Mailing Address - Fax:662-473-2921
Practice Address - Street 1:409 DUNCAN ST
Practice Address - Street 2:
Practice Address - City:WATER VALLEY
Practice Address - State:MS
Practice Address - Zip Code:38965-2547
Practice Address - Country:US
Practice Address - Phone:662-473-3333
Practice Address - Fax:662-473-2921
Is Sole Proprietor?:No
Enumeration Date:2017-08-31
Last Update Date:2017-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSE5833183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist