Organization
REGION IV MH MR COMMISSION PHCY
Active
Other names
REGION IV MH MR COMMISSION PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
CHARLIE SPEARMAN (EXECUTIVE DIRECTOR)
(662) 286-9883
Entity
Organization
Contact information
Practice address
2301B E CHAMBERS DR, BOONEVILLE, MS 38829
(662) 728-3174
(662) 728-3159
Mailing address
PO BOX 716, BOONEVILLE, MS 38829-0716
Taxonomy
Speciality
Code
Description
License number
State
3336C0002X
Clinic Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
06596/1.1
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2047211
PK
—
Enumeration date
10/23/2006
Last updated
08/30/2016
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