Provider Demographics
NPI:1649364662
Name:CENTER PHARMACY
Entity type:Organization
Organization Name:CENTER PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BARRY
Authorized Official - Middle Name:
Authorized Official - Last Name:MONDAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-579-4453
Mailing Address - Street 1:1 LINCOLN PKWY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39402-3262
Mailing Address - Country:US
Mailing Address - Phone:601-261-4045
Mailing Address - Fax:601-261-2779
Practice Address - Street 1:1 LINCOLN PKWY
Practice Address - Street 2:SUITE 100
Practice Address - City:HATTIESBURG
Practice Address - State:MS
Practice Address - Zip Code:39402-3262
Practice Address - Country:US
Practice Address - Phone:601-261-4045
Practice Address - Fax:601-261-2779
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183700000XPharmacy Service ProvidersPharmacy TechnicianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS08753029Medicaid