1922608306 NPI number — SHIRLEY BRIANNE POUNDERS PHARMD

Table of content: SHIRLEY BRIANNE POUNDERS PHARMD (NPI 1922608306)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1922608306 NPI number — SHIRLEY BRIANNE POUNDERS PHARMD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
POUNDERS
Provider First Name:
SHIRLEY
Provider Middle Name:
BRIANNE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PHARMD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1922608306
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/27/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 94
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
COMO
Provider Business Mailing Address State Name:
MS
Provider Business Mailing Address Postal Code:
38619-0094
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
901-674-2195
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1000 S STATE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CLARKSDALE
Provider Business Practice Location Address State Name:
MS
Provider Business Practice Location Address Postal Code:
38614-4704
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
662-624-2523
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/27/2020

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 183500000X , with the licence number:  E-14920 , registered in the state of MS ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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