Provider Demographics
NPI:1578956264
Name:ALLIANCE HEALTHCARE SYSTEM
Entity Type:Organization
Organization Name:ALLIANCE HEALTHCARE SYSTEM
Other - Org Name:WMC PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:662-252-1599
Mailing Address - Street 1:1938 CRESCENT MEADOWS DR
Mailing Address - Street 2:
Mailing Address - City:HOLLY SPRINGS
Mailing Address - State:MS
Mailing Address - Zip Code:38635-7419
Mailing Address - Country:US
Mailing Address - Phone:662-252-1599
Mailing Address - Fax:662-252-1986
Practice Address - Street 1:1938 CRESCENT MEADOWS DR
Practice Address - Street 2:
Practice Address - City:HOLLY SPRINGS
Practice Address - State:MS
Practice Address - Zip Code:38635-7419
Practice Address - Country:US
Practice Address - Phone:662-252-1599
Practice Address - Fax:662-252-1986
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-05
Last Update Date:2015-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0002XSuppliersPharmacyClinic Pharmacy