Provider Demographics
NPI:1609923754
Name:DOGWOOD FAMILY PHARMACY INC
Entity Type:Organization
Organization Name:DOGWOOD FAMILY PHARMACY INC
Other - Org Name:DOGWOOD FAMILY PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PIC
Authorized Official - Prefix:
Authorized Official - First Name:CATINA
Authorized Official - Middle Name:
Authorized Official - Last Name:HINTON
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:662-869-8383
Mailing Address - Street 1:PO BOX 1506
Mailing Address - Street 2:
Mailing Address - City:SALTILLO
Mailing Address - State:MS
Mailing Address - Zip Code:38866-1506
Mailing Address - Country:US
Mailing Address - Phone:662-869-8383
Mailing Address - Fax:662-869-1980
Practice Address - Street 1:103 TOWN CREEK DR
Practice Address - Street 2:
Practice Address - City:SALTILLO
Practice Address - State:MS
Practice Address - Zip Code:38866-7947
Practice Address - Country:US
Practice Address - Phone:662-869-8383
Practice Address - Fax:662-869-1980
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-04
Last Update Date:2010-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
MS054373336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00330674Medicaid
2521056OtherNCPDP PROVIDER IDENTIFICATION NUMBER
4554860001Medicare NSC