Organization
SHILOH APOTHECARY INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RAYMOND LAFAYETTE MATHIS PHARM.D. (PRESIDENT/OWNER)
(662) 594-1573
Entity
Organization
Contact information
Practice address
2049 E SHILOH RD, CORINTH, MS 38834-3726
(662) 594-1573
(662) 594-1628
Mailing address
2049 E SHILOH RD, CORINTH, MS 38834-3726
(662) 594-1573
(662) 594-1628
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
16600
MS
3336C0004X
Compounding Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
06132758
—
MS
Enumeration date
11/19/2017
Last updated
01/09/2024
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