Provider Demographics
NPI:1902841265
Name:DUTCH PHARMACIES INC
Entity Type:Organization
Organization Name:DUTCH PHARMACIES INC
Other - Org Name:FAMILY PHARMACY OF FULTON
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PIC
Authorized Official - Prefix:
Authorized Official - First Name:CYNDI
Authorized Official - Middle Name:
Authorized Official - Last Name:BOWEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:662-862-7979
Mailing Address - Street 1:1313 S ADAMS ST
Mailing Address - Street 2:
Mailing Address - City:FULTON
Mailing Address - State:MS
Mailing Address - Zip Code:38843-8862
Mailing Address - Country:US
Mailing Address - Phone:662-862-7979
Mailing Address - Fax:662-862-7843
Practice Address - Street 1:1313 S ADAMS ST
Practice Address - Street 2:
Practice Address - City:FULTON
Practice Address - State:MS
Practice Address - Zip Code:38843-8862
Practice Address - Country:US
Practice Address - Phone:662-862-7979
Practice Address - Fax:662-862-7843
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-19
Last Update Date:2016-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
MS07471/01.23336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2045919OtherPK