Provider Demographics
NPI:1851841167
Name:THE PHARMACY OF MERIDIAN
Entity Type:Organization
Organization Name:THE PHARMACY OF MERIDIAN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:MAJURE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-693-2655
Mailing Address - Street 1:PO BOX 5105
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:MS
Mailing Address - Zip Code:39302-5105
Mailing Address - Country:US
Mailing Address - Phone:601-693-2655
Mailing Address - Fax:
Practice Address - Street 1:626 22ND AVE S
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:MS
Practice Address - Zip Code:39301-6120
Practice Address - Country:US
Practice Address - Phone:601-693-3285
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-11
Last Update Date:2016-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS07342/01.13336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy