Provider Demographics
NPI:1346096898
Name:PRECISION PHARMACY WELLNESS AND COMPOUNDING LLC
Entity Type:Organization
Organization Name:PRECISION PHARMACY WELLNESS AND COMPOUNDING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE-PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:EARL
Authorized Official - Last Name:CRAWFORD
Authorized Official - Suffix:III
Authorized Official - Credentials:RPH
Authorized Official - Phone:601-255-0010
Mailing Address - Street 1:6766 U S HIGHWAY 98
Mailing Address - Street 2:
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39402-8443
Mailing Address - Country:US
Mailing Address - Phone:601-255-0010
Mailing Address - Fax:601-255-0309
Practice Address - Street 1:6766 U S HIGHWAY 98
Practice Address - Street 2:
Practice Address - City:HATTIESBURG
Practice Address - State:MS
Practice Address - Zip Code:39402-8443
Practice Address - Country:US
Practice Address - Phone:601-255-0010
Practice Address - Fax:601-255-0309
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-25
Last Update Date:2024-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy