Organization
UNIVERSITY OF SOUTHERN MISSISSIPPI
Active
Other names
B EMMELINE SMITH CLINIC
Organization subpart
No
Provider details
NPI number
Authorized official
CELESTE TISDALE RPH (PHCY MNGR)
(601) 266-4075
Entity
Organization
Contact information
Practice address
118 COLLEGE DR, STE 5066, HATTIESBURG, MS 39406-0002
(601) 266-4075
(601) 266-4205
Mailing address
118 COLLEGE DR, STE 5066, HATTIESBURG, MS 39406-0002
(601) 266-4075
(601) 266-4205
Taxonomy
Speciality
Code
Description
License number
State
3336C0002X
Clinic Pharmacy
Primary
01065
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2518491
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
04/03/2007
Last updated
07/14/2010
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