Organization · NPI-2

Hattiesburg Clinic PA

Pharmacy, Community/Retail Pharmacy · Hattiesburg, MS

NPI number1407861016

StatusActive

Last updated in NPPESFeb 21, 2017

Details

NPI: 1407861016
Entity type: Organization (NPI-2)
Legal business name: Hattiesburg Clinic PA
Organization subpart: No
Enumeration date: Jul 30, 2006
Last updated: Feb 21, 2017

Taxonomy and licenses

Taxonomy code	Description	License	State	Primary
3336C0003X	Pharmacy, Community/Retail Pharmacy	01821/1.1	MS	Yes
333600000X	Pharmacy	–	–
3336L0003X	Pharmacy, Long Term Care Pharmacy	–	–

Other names

Owl Drug Store (Doing Business As)

Practice location

Medical Blvd
Ste 2
Hattiesburg, MS 39401

Phone 601-268-5740 · Fax 601-268-5858

Mailing address

Medical Blvd
Ste 2
Hattiesburg, MS 39401

Phone 601-268-5740 · Fax 601-268-5858

Authorized official

Diane Ashley
Phcy Dir
6012682740

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