Organization
MEDI MART PHARMACIES OF MISSISSIPPI, INC.
Active
Other names
Medi Mart Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
MR. CLARENCE E. DUBOSE SR. R.PH. (PRESIDENT)
(228) 474-1011
Entity
Organization
Contact information
Practice address
3737 MAIN ST, MOSS POINT, MS 39563-5107
(228) 474-1011
(228) 474-1033
Mailing address
3737 MAIN ST, MOSS POINT, MS 39563-5107
(228) 474-1011
(228) 474-1033
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
01148/01.1
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00030113
—
MS
Enumeration date
10/03/2006
Last updated
08/22/2020
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