Organization
CONTROLEX ENTERPRISES, INC.
Active
Other names
SOUTHWEST SAVREX #632
Organization subpart
No
Provider details
NPI number
Authorized official
MS. MODENA S CANNON (PHARMACY OPERATIONS MANAGER)
(228) 769-7067
Entity
Organization
Contact information
Practice address
1714 DENNY AVE, PASCAGOULA, MS 39567-3303
(228) 762-7192
Mailing address
1420 INGALLS AVE, PASCAGOULA, MS 39567-5650
(228) 769-7067
(228) 762-1756
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
Primary
00842/01.2
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00092568
—
MS
01
—
2506422
NCPDP
MS
Enumeration date
10/19/2006
Last updated
08/22/2020
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