Organization
NORTHEAST MENTAL HEALTH MENTAL RETARDATION COMMISSION
Active
Other names
LIFECORE PHARMACY, AMORY
Organization subpart
No
Provider details
NPI number
Authorized official
VAN WATSON BS OF PHARMACY (VP OF PHARMACY DIVISION)
(662) 634-4347
Entity
Organization
Contact information
Practice address
317 MAIN ST N, AMORY, MS 38821-3420
(662) 634-4347
(662) 256-5567
Mailing address
317 MAIN ST N, AMORY, MS 38821-3420
(662) 634-4347
(662) 256-5567
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
07162/5.2
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
05123737
—
MS
01
—
2047457
PK
—
Enumeration date
01/03/2007
Last updated
07/19/2018
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