Provider Demographics
NPI:1285344689
Name:KING'S DAUGHTERS MEDIAL CENTER
Entity type:Organization
Organization Name:KING'S DAUGHTERS MEDIAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF PHARMACY
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:WALLACE
Authorized Official - Last Name:FREEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:601-835-9157
Mailing Address - Street 1:427 HIGHWAY 51 NORTH
Mailing Address - Street 2:RETAIL PHARMACY
Mailing Address - City:BROOKHAVEN
Mailing Address - State:MS
Mailing Address - Zip Code:39601
Mailing Address - Country:US
Mailing Address - Phone:601-835-9462
Mailing Address - Fax:
Practice Address - Street 1:427 HIGHWAY 51 NORTH
Practice Address - Street 2:RETAIL PHARMACY
Practice Address - City:BROOKHAVEN
Practice Address - State:MS
Practice Address - Zip Code:39601
Practice Address - Country:US
Practice Address - Phone:601-835-9462
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KING'S DAUGHTERS MEDIAL CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-11-28
Last Update Date:2022-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy