Provider Demographics
NPI:1669481875
Name:BARNETT APOTHECARY, LLC
Entity Type:Organization
Organization Name:BARNETT APOTHECARY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PHARMACIST
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:STEPHEN
Authorized Official - Last Name:BARNETT
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:662-423-9994
Mailing Address - Street 1:PO BOX 60
Mailing Address - Street 2:
Mailing Address - City:IUKA
Mailing Address - State:MS
Mailing Address - Zip Code:38852
Mailing Address - Country:US
Mailing Address - Phone:662-423-9994
Mailing Address - Fax:662-423-9987
Practice Address - Street 1:606 BATTLEGROUND DR
Practice Address - Street 2:
Practice Address - City:IUKA
Practice Address - State:MS
Practice Address - Zip Code:38852
Practice Address - Country:US
Practice Address - Phone:662-423-9994
Practice Address - Fax:662-423-9987
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-05
Last Update Date:2011-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS05564011183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS0330696Medicaid
MS0330696Medicaid