Provider Demographics
NPI:1134493851
Name:TOWNE MARKET
Entity Type:Organization
Organization Name:TOWNE MARKET
Other - Org Name:TOWNE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:
Authorized Official - Last Name:BATISTE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-353-5523
Mailing Address - Street 1:6 SIEBENKITTEL CIR STE B
Mailing Address - Street 2:
Mailing Address - City:CARRIERE
Mailing Address - State:MS
Mailing Address - Zip Code:39426-8778
Mailing Address - Country:US
Mailing Address - Phone:601-353-5523
Mailing Address - Fax:225-282-1004
Practice Address - Street 1:6 SIEBENKITTEL CIR STE B
Practice Address - Street 2:
Practice Address - City:CARRIERE
Practice Address - State:MS
Practice Address - Zip Code:39426-8778
Practice Address - Country:US
Practice Address - Phone:601-353-5523
Practice Address - Fax:225-282-1004
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-27
Last Update Date:2012-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS1079/1.13336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS1079/1.1Medicaid