Provider Demographics
NPI:1366120388
Name:AVENT, MEGAN MARIE (PHARMD)
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:MARIE
Last Name:AVENT
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1309 HIGHWAY 35 S
Mailing Address - Street 2:
Mailing Address - City:FOREST
Mailing Address - State:MS
Mailing Address - Zip Code:39074-5010
Mailing Address - Country:US
Mailing Address - Phone:601-469-2190
Mailing Address - Fax:601-469-2176
Practice Address - Street 1:1309 HIGHWAY 35 S
Practice Address - Street 2:
Practice Address - City:FOREST
Practice Address - State:MS
Practice Address - Zip Code:39074-5010
Practice Address - Country:US
Practice Address - Phone:601-469-2190
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-10
Last Update Date:2023-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSE-101101183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist