Provider Demographics
NPI:1578955381
Name:UPTOWN PHARMACY
Entity Type:Organization
Organization Name:UPTOWN PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JIMMY
Authorized Official - Middle Name:D
Authorized Official - Last Name:YAWN
Authorized Official - Suffix:II
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:601-631-1667
Mailing Address - Street 1:119 PLANTERS ROW
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:MS
Mailing Address - Zip Code:39110-7990
Mailing Address - Country:US
Mailing Address - Phone:601-631-1667
Mailing Address - Fax:
Practice Address - Street 1:1042 GLUCKSTADT RD
Practice Address - Street 2:SUITE D
Practice Address - City:MADISON
Practice Address - State:MS
Practice Address - Zip Code:39110-6981
Practice Address - Country:US
Practice Address - Phone:601-631-1667
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-03
Last Update Date:2015-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS142503336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy