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
—
—
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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