Provider Demographics
NPI:1841235603
Name:CARSON NATURAL HEALTH CENTER INC
Entity Type:Organization
Organization Name:CARSON NATURAL HEALTH CENTER INC
Other - Org Name:CARSON NATURAL HEALTH CENTER INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER AND PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:S PHILLIP
Authorized Official - Middle Name:
Authorized Official - Last Name:CARSON
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:662-257-1012
Mailing Address - Street 1:PO BOX 111
Mailing Address - Street 2:
Mailing Address - City:AMORY
Mailing Address - State:MS
Mailing Address - Zip Code:38821-0111
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:122 MAIN ST N
Practice Address - Street 2:
Practice Address - City:AMORY
Practice Address - State:MS
Practice Address - Zip Code:38821-3415
Practice Address - Country:US
Practice Address - Phone:662-257-1012
Practice Address - Fax:662-257-1014
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-17
Last Update Date:2009-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 333600000X, 3336C0004X, 3336L0003X, 3336M0002X
MS069350113336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No3336M0002XSuppliersPharmacyMail Order Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00488594Medicaid
2586494OtherNCPDP PROVIDER IDENTIFICATION NUMBER
MS02739746Medicaid
2586494OtherNCPDP PROVIDER IDENTIFICATION NUMBER