Provider Demographics
NPI:1649883844
Name:NATCHEZ WELLNESS PHARMACY
Entity type:Organization
Organization Name:NATCHEZ WELLNESS PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:BRIANA
Authorized Official - Middle Name:
Authorized Official - Last Name:POLICARPO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-653-0302
Mailing Address - Street 1:29 SERGEANT PRENTISS DR STE 5
Mailing Address - Street 2:
Mailing Address - City:NATCHEZ
Mailing Address - State:MS
Mailing Address - Zip Code:39120-4743
Mailing Address - Country:US
Mailing Address - Phone:601-653-0203
Mailing Address - Fax:601-653-1022
Practice Address - Street 1:29 SERGEANT PRENTISS DR STE 5
Practice Address - Street 2:
Practice Address - City:NATCHEZ
Practice Address - State:MS
Practice Address - Zip Code:39120-4743
Practice Address - Country:US
Practice Address - Phone:601-653-0203
Practice Address - Fax:601-653-1022
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-26
Last Update Date:2022-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy