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Organization
HORN LAKE FAMILY PRACTICE
Active
Organization
HORN LAKE FAMILY PRACTICE
Active
Other names
Horn Lake Family Practice
Organization subpart
No
Provider details
NPI number
Authorized official
SHEETAL SHARMA (MEMBER)
(662) 342-6677
Entity
Organization
Contact information
Practice address
3102 GOODMAN RD W, HORN LAKE, MS 38637-1172
(662) 342-6677
(662) 342-0203
Mailing address
1019 GOVERNMENT ST, SUITE F, OCEAN SPRINGS, MS 39564-3860
(228) 447-3823
(228) 447-3812
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
14467
MS
3336C0004X
Compounding Pharmacy
—
NULL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2153358
PK
—
Enumeration date
08/27/2015
Last updated
02/18/2016
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