Provider Demographics
NPI:1205353794
Name:HURT, CHANDRA STOKES (PHD)
Entity type:Individual
Prefix:
First Name:CHANDRA
Middle Name:STOKES
Last Name:HURT
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:CHANDRA
Other - Middle Name:ALLISON
Other - Last Name:STOKES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:150 COUNTY ROAD 543
Mailing Address - Street 2:
Mailing Address - City:RIPLEY
Mailing Address - State:MS
Mailing Address - Zip Code:38663-9406
Mailing Address - Country:US
Mailing Address - Phone:662-210-0571
Mailing Address - Fax:
Practice Address - Street 1:1317 E MAIN ST
Practice Address - Street 2:
Practice Address - City:TUPELO
Practice Address - State:MS
Practice Address - Zip Code:38804-2953
Practice Address - Country:US
Practice Address - Phone:662-680-4959
Practice Address - Fax:662-680-4962
Is Sole Proprietor?:No
Enumeration Date:2017-08-24
Last Update Date:2017-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSE-010148183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist