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Organization
PIONEER FAMILY PHARMACY
Active
Organization
PIONEER FAMILY PHARMACY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JERRY MATTHEW FORTENBERRY RPH (PHARMACIST NI CHARGE)
(601) 937-1672
Entity
Organization
Contact information
Practice address
502 JACKSON ST, SUITE 1, ABERDEEN, MS 39730-3300
(662) 369-4249
(662) 304-4018
Mailing address
502 JACKSON ST, SUITE 1, ABERDEEN, MS 39730-3300
(662) 369-4249
(662) 304-4018
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
06748
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
06229094
—
MI
01
—
2586317
NABP
MI
Enumeration date
03/27/2007
Last updated
03/07/2023
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