# HATTIESBURG CLINIC PA

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Organization
- **Status:** Active
- **Other names:** OWL DRUG STORE
- **Organization subpart:** No

## Provider details

- **NPI number:** 1407861016
- **Authorized official:** DIANE ASHLEY RPH (PHCY DIR)
- **Authorized official phone:** (601) 268-2740

## Contact information

- **Practice address:** MEDICAL BLVD, STE 2, HATTIESBURG, MS 39401
- **Practice address phone:** (601) 268-5740
- **Practice address fax:** (601) 268-5858
- **Mailing address:** MEDICAL BLVD, STE 2, HATTIESBURG, MS 39401
- **Mailing address phone:** (601) 268-5740
- **Mailing address fax:** (601) 268-5858

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 333600000X | Pharmacy | — | NULL | — |
| 3336C0003X | Community/Retail Pharmacy | 01821/1.1 | MS | Yes |
| 3336L0003X | Long Term Care Pharmacy | — | NULL | — |

## Other

- **Enumeration date:** 07/30/2006
- **Last updated:** 02/21/2017

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 00030291 | — | MS |
| 01 | — | 2045095 | PK | — |