Organization · NPI-2

Economic Stimulus Act Student Loan Refund 1200 Dollars

Pharmacy · Hattiesburg, MS

NPI number1255999835

StatusActive

Last updated in NPPESSep 30, 2020

Details

NPI: 1255999835
Entity type: Organization (NPI-2)
Legal business name: Economic Stimulus Act Student Loan Refund 1200 Dollars
Organization subpart: Yes
Enumeration date: May 30, 2019
Certification date: Sep 30, 2020
Last updated: Sep 30, 2020

Taxonomy and licenses

Taxonomy code	Description	License	State	Primary
333600000X	Pharmacy	–	–	Yes
261Q00000X	Clinic/Center	–	–
261QG0250X	Clinic/Center, Genetics	–	–
261QS1000X	Clinic/Center, Student Health	–	–
293D00000X	Physiological Laboratory	–	–

Other names

Economic Stimulus Act Student Loan Refund 1200 Dollars (Former Legal Business Name)
Epic Systems Corporation Applied Informatics Physician (Former Legal Business Name)

Practice location

5001 Hardy St Ste 8
Hattiesburg, MS 39402-1308

Phone 601-307-5339

Mailing address

3301 N Milwaukee St
Denver, CO 80205-4322

Phone 650-253-0000

Authorized official

Jacob Cornelius Parker
Specialist Technologist
6502530000

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