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Organization
WALNUT SQUARE PHARMACY LLC
Active
Organization
WALNUT SQUARE PHARMACY LLC
Active
Other names
WALNUT SQUARE PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
STEPHEN WORREL PHARMD (CFO)
(601) 583-3232
Entity
Organization
Contact information
Practice address
124 WALNUT CIR, STE 3, HATTIESBURG, MS 39401-3500
(601) 543-0111
(601) 543-0208
Mailing address
124 WALNUT CIR, STE 3, HATTIESBURG, MS 39401-3500
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
NULL
3336C0003X
Community/Retail Pharmacy
Primary
05515011
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0330691
—
MS
01
—
2521082
OTHER ID NUMBER-COMMERCIAL NUMBER
—
Enumeration date
02/07/2007
Last updated
09/12/2007
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