# MEDI CENTER PHARMACY

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1093883233
- **Authorized official:** AUDRIC CHOW PHRM (OWNER)
- **Authorized official phone:** (662) 624-6561

## Contact information

- **Practice address:** 1629 N STATE ST, CLARKSDALE, MS 38614-6617
- **Practice address phone:** (662) 624-6561
- **Practice address fax:** (662) 627-2845
- **Mailing address:** 1629 N STATE ST, CLARKSDALE, MS 38614-6617
- **Mailing address phone:** (662) 624-6561
- **Mailing address fax:** (662) 624-6562

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 333600000X | Pharmacy | 01632011 | MS | — |
| 3336C0003X | Community/Retail Pharmacy | — | NULL | Yes |

## Other

- **Enumeration date:** 12/04/2006
- **Last updated:** 08/13/2007

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 00095109 | — | MS |
| 01 | — | 2511043 | OTHER ID NUMBER-COMMERCIAL NUMBER | — |