Provider Demographics
NPI:1225631062
Name:PEARSON, TANYA MICHELLE (RPH)
Entity Type:Individual
Prefix:
First Name:TANYA
Middle Name:MICHELLE
Last Name:PEARSON
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 HEDGEMOOR CIR
Mailing Address - Street 2:
Mailing Address - City:AMORY
Mailing Address - State:MS
Mailing Address - Zip Code:38821-2600
Mailing Address - Country:US
Mailing Address - Phone:662-256-8165
Mailing Address - Fax:662-256-8186
Practice Address - Street 1:60379 COTTON GIN PORT RD STE B
Practice Address - Street 2:
Practice Address - City:AMORY
Practice Address - State:MS
Practice Address - Zip Code:38821-7204
Practice Address - Country:US
Practice Address - Phone:662-256-8165
Practice Address - Fax:662-256-8186
Is Sole Proprietor?:No
Enumeration Date:2020-11-16
Last Update Date:2020-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSE-08226183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MSE-08226OtherSTATE LICENSE