Organization
THIRTEENTH AVENUE PHARMACY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KYLE MAULDIN R.PH. (OWNER PHARMACIST)
(601) 428-7257
Entity
Organization
Contact information
Practice address
216 S 13TH AVE, LAUREL, MS 39440-4226
(601) 428-7257
Mailing address
216 S 13TH AVE, LAUREL, MS 39440-4226
(601) 428-7257
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
01527
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00330499
—
MS
Enumeration date
04/12/2007
Last updated
08/22/2020
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