Organization
VAN DEV ENTERPRISES INC
Active
Other names
MCDANIEL PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
DAPHYNE VANDEVENDER PD (OWNER)
(601) 437-5121
Entity
Organization
Contact information
Practice address
1005 MARKET ST, PORT GIBSON, MS 39150-2337
(601) 437-5121
(601) 437-5102
Mailing address
PO BOX 1024, PORT GIBSON, MS 39150-1024
(601) 437-5121
(601) 437-5102
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
00680
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0330665
—
MS
01
—
2506737
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
09/14/2006
Last updated
02/25/2010
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