Provider Demographics
NPI:1417600792
Name:TEDFORD, DAVID PRICE JR (PHARMD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:PRICE
Last Name:TEDFORD
Suffix:JR
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 W RAILROAD ST
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:MS
Mailing Address - Zip Code:39560-4634
Mailing Address - Country:US
Mailing Address - Phone:228-575-4057
Mailing Address - Fax:228-575-4458
Practice Address - Street 1:120 W RAILROAD ST
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:MS
Practice Address - Zip Code:39560-4634
Practice Address - Country:US
Practice Address - Phone:228-575-4057
Practice Address - Fax:228-575-4458
Is Sole Proprietor?:No
Enumeration Date:2022-01-27
Last Update Date:2022-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS100418183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist