Provider Demographics
NPI:1093701526
Name:PEYTEN, LTD.
Entity Type:Organization
Organization Name:PEYTEN, LTD.
Other - Org Name:CLINIC PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PHARMACIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JULIA
Authorized Official - Middle Name:C
Authorized Official - Last Name:TENNIN
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:601-407-1440
Mailing Address - Street 1:1883 HIGHWAY 43 S
Mailing Address - Street 2:SUITE A
Mailing Address - City:CANTON
Mailing Address - State:MS
Mailing Address - Zip Code:39046-8405
Mailing Address - Country:US
Mailing Address - Phone:601-407-1440
Mailing Address - Fax:601-407-1441
Practice Address - Street 1:1883 HIGHWAY 43 S
Practice Address - Street 2:SUITE A
Practice Address - City:CANTON
Practice Address - State:MS
Practice Address - Zip Code:39046-8405
Practice Address - Country:US
Practice Address - Phone:601-407-1440
Practice Address - Fax:601-407-1441
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSE7245183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS07775397Medicaid
MS08673232Medicaid
MS0253810003Medicare NSC