Provider Demographics
NPI:1851818637
Name:SISTRUNK, JOSEPH ANDREW (PHARMD)
Entity type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:ANDREW
Last Name:SISTRUNK
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 1:219 N WOODLAND DR
Mailing Address - Street 2:
Mailing Address - City:FOREST
Mailing Address - State:MS
Mailing Address - Zip Code:39074-3307
Mailing Address - Country:US
Mailing Address - Phone:601-469-3393
Mailing Address - Fax:601-469-5965
Practice Address - Street 1:219 N WOODLAND DR
Practice Address - Street 2:
Practice Address - City:FOREST
Practice Address - State:MS
Practice Address - Zip Code:39074-3307
Practice Address - Country:US
Practice Address - Phone:601-469-3393
Practice Address - Fax:601-469-5965
Is Sole Proprietor?:No
Enumeration Date:2017-08-23
Last Update Date:2025-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSE-09749183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist