Region 12 Commission On Mental Health & Retardation Pine
Community/Retail Pharmacy
103 S 19th Ave, Hattiesburg
Mississippi, 39401-6171
601-544-4641 601-450-4632
Region 12 Commission On Mental Health & Retardation Pine is a Community/Retail Pharmacy in Hattiesburg, Mississippi. It is located at 103 S 19th Ave, Hattiesburg and it's customer support contact number is 601-544-4641. The authorized person of Region 12 Commission On Mental Health & Retardation Pine is Jerry Mayo who is Ceo of the pharmacy and his contact number is 601-544-4641. Active license number of Region 12 Commission On Mental Health & Retardation Pine is 07864/5.1 for Community/Retail Pharmacy in Mississippi.
Region 12 Commission On Mental Health & Retardation Pine is a pharmacy where pharmacists store, prepare, and dispense medicinal preparations and/or prescriptions for a local patient population in accordance with federal and state law; counsel patients and caregivers (sometimes independent of the dispensing process); administer vaccinations; and provide other professional services associated with pharmaceutical care such as health screenings, consultative services with other health care providers, collaborative practice, disease state management, and education classes.
Pharmacy Details:
Region 12 Commission On Mental Health & Retardation Pine type, location, contact phone number and fax are as below. Patients can directly walkin to the pharmacy or can call on the below given customer support phone number for enquiries.
| Name: | Region 12 Commission On Mental Health & Retardation Pine |
| Type: | Community/Retail Pharmacy |
| Location: | 103 S 19th Ave, Hattiesburg,
Mississippi, 39401-6171 |
| Phone: | 601-544-4641 |
| Fax: | 601-450-4632 |
Authorized/Official Person Profile:
Officially authorized person to contact for any management issues or complaints of this pharmacy is as below. Person's position and contact details are also mentioned below.
| Name: | Jerry Mayo |
| Position: | Ceo |
| Contact Number: | 601-544-4641 |
Professional Identification Codes:
NPI number stands for National Provider Identifier which is a unique 10-digit identification number issued to health care providers in the United States by the Centers for Medicare and Medicaid Services (CMS).
NPI details of given pharmacy are as mentioned below.
| NPI Number: | 1861645657 |
| NPI Enumeration Date: | 24 Oct, 2008 |
| NPI Last Update On: | 16 Feb, 2017 |
Medical Licenses:
Organizations can have one or more medical licenses for different specialities in the same state or different states. Related medical licenses for Region 12 Commission On Mental Health & Retardation Pine are as mentioned below.
| Specialization | License Number | State | Status | |
| Community/Retail Pharmacy | 07864/5.1 | Mississippi | Primary | |
| Pharmacy | | | Secondary | |
Other Medical Identifiers:
Other legacy medical identifiers of the pharmacy such as Medicaid, Medicare PIN, NSC, UPIN etc. are mentioned as below.
| Identifier | Type | State | Issuer |
| 2117558 | Other | | Pk |
Business Mailing Address:
Business mailing address can be used for mailing purpose only, for visiting purpose patients need to refer above mentioned address.
| Address: | 103 S 19th Ave,
Hattiesburg, Mississippi |
| Zip: | 39401-6171 |
| Phone Number: | 601-544-4641 |
| Fax Number: | 601-450-4632 |
Patients can reach Region 12 Commission On Mental Health & Retardation Pine at
103 S 19th Ave, Hattiesburg, Mississippi or can
call on customer care at 601-544-4641.
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**Data of this site is collected from Medicare & Medicaid Services (CMS) and NPPES. Last updated on 08 December, 2025.