Provider Demographics
NPI:1942902796
Name:PRECISION PHARMACY WELLNESS AND COMPOUNDING LLC
Entity Type:Organization
Organization Name:PRECISION PHARMACY WELLNESS AND COMPOUNDING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:EARL
Authorized Official - Last Name:CRAWFORD
Authorized Official - Suffix:III
Authorized Official - Credentials:RPH
Authorized Official - Phone:601-498-8576
Mailing Address - Street 1:6766 U S HIGHWAY 98 STE 8
Mailing Address - Street 2:
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39402-8443
Mailing Address - Country:US
Mailing Address - Phone:601-498-8576
Mailing Address - Fax:
Practice Address - Street 1:6766 U S HIGHWAY 98 STE 8
Practice Address - Street 2:
Practice Address - City:HATTIESBURG
Practice Address - State:MS
Practice Address - Zip Code:39402-8443
Practice Address - Country:US
Practice Address - Phone:601-498-8576
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-17
Last Update Date:2023-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy