Provider Demographics
NPI:1841838463
Name:PATTERSON, TONY ALLEN (PHARMD)
Entity type:Individual
Prefix:
First Name:TONY
Middle Name:ALLEN
Last Name:PATTERSON
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7045 OLD CANTON RD
Mailing Address - Street 2:
Mailing Address - City:RIDGELAND
Mailing Address - State:MS
Mailing Address - Zip Code:39157-1036
Mailing Address - Country:US
Mailing Address - Phone:601-856-0977
Mailing Address - Fax:601-856-1492
Practice Address - Street 1:7045 OLD CANTON RD
Practice Address - Street 2:
Practice Address - City:RIDGELAND
Practice Address - State:MS
Practice Address - Zip Code:39157-1036
Practice Address - Country:US
Practice Address - Phone:601-856-0977
Practice Address - Fax:601-856-1492
Is Sole Proprietor?:No
Enumeration Date:2019-12-13
Last Update Date:2020-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSE-091861835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist