Provider Demographics
NPI:1467099424
Name:MATTOX, JOSHUA (PHARMD)
Entity Type:Individual
Prefix:
First Name:JOSHUA
Middle Name:
Last Name:MATTOX
Suffix:
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 1:107 HIGHWAY 80 E
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:MS
Mailing Address - Zip Code:39056-4738
Mailing Address - Country:US
Mailing Address - Phone:601-925-6343
Mailing Address - Fax:601-925-6344
Practice Address - Street 1:107 HIGHWAY 80 E
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:MS
Practice Address - Zip Code:39056-4738
Practice Address - Country:US
Practice Address - Phone:601-925-6343
Practice Address - Fax:601-925-6344
Is Sole Proprietor?:No
Enumeration Date:2019-12-09
Last Update Date:2019-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSE16036183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist