Provider Demographics
NPI:1295091023
Name:OXFORD FAMILY PHARMACY
Entity type:Organization
Organization Name:OXFORD FAMILY PHARMACY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:BASKERVILLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:662-234-6315
Mailing Address - Street 1:2209 S LAMAR BLVD
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:MS
Mailing Address - Zip Code:38655-5225
Mailing Address - Country:US
Mailing Address - Phone:662-234-6315
Mailing Address - Fax:662-513-4078
Practice Address - Street 1:2209 S LAMAR BLVD
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:MS
Practice Address - Zip Code:38655-5225
Practice Address - Country:US
Practice Address - Phone:662-234-6315
Practice Address - Fax:662-513-4078
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-05
Last Update Date:2012-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS002693336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2588777OtherNCPDP PROVIDER IDENTIFICATION NUMBER