Organization
NORTHEAST MENTAL HEALTH-MENTAL RETARDATION COMMISSION
Active
Other names
Lifecore Pharmacy Tupelo
Organization subpart
No
Provider details
NPI number
Authorized official
VAN WATSON BS PHARMACY (DIRECTOR OF PHARMACY)
(662) 912-5006
Entity
Organization
Contact information
Practice address
499 GLOSTER CREEK VLG STE A3, TUPELO, MS 38801-4600
(662) 912-5006
(662) 680-5125
Mailing address
499 GLOSTER CREEK VLG STE A3, TUPELO, MS 38801-4600
(662) 912-5006
(662) 680-5125
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
12959/5.1
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
07371351
—
MS
01
—
2143598
PK
—
Enumeration date
11/27/2013
Last updated
04/19/2017
Update your record
If you believe information in your NPPES record is inaccurate, or if you wish to update or deactivate your NPI, you can do so directly with CMS at https://nppes.cms.hhs.gov.
About Stedi
Stedi is the only programmable healthcare clearinghouse. You can use Stedi's APIs to process eligibility checks, claims, remits, and more.
Sign up