# MEDI MART PHARMACIES OF MISSISSIPPI, INC.

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Medi Mart Pharmacy
- **Organization subpart:** No

## Provider details

- **NPI number:** 1043304033
- **Authorized official:** MR. CLARENCE E. DUBOSE SR. R.PH. (PRESIDENT)
- **Authorized official phone:** (228) 474-1011

## Contact information

- **Practice address:** 3737 MAIN ST, MOSS POINT, MS 39563-5107
- **Practice address phone:** (228) 474-1011
- **Practice address fax:** (228) 474-1033
- **Mailing address:** 3737 MAIN ST, MOSS POINT, MS 39563-5107
- **Mailing address phone:** (228) 474-1011
- **Mailing address fax:** (228) 474-1033

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 3336C0003X | Community/Retail Pharmacy | 01148/01.1 | MS | Yes |

## Other

- **Enumeration date:** 10/03/2006
- **Last updated:** 08/22/2020

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 00030113 | — | MS |