Provider Demographics
NPI:1376135319
Name:KINCAID, DAVID M
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:M
Last Name:KINCAID
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1105
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:MS
Mailing Address - Zip Code:38655-1105
Mailing Address - Country:US
Mailing Address - Phone:662-234-4843
Mailing Address - Fax:
Practice Address - Street 1:300 HERITAGE DR STE 200
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:MS
Practice Address - Zip Code:38655-5463
Practice Address - Country:US
Practice Address - Phone:662-234-4843
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-10
Last Update Date:2021-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS181293336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy