# EMMANUEL RIDGE COMM PHCY

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1073524583
- **Authorized official:** BEATRICE EZEM RN CM CLNC (PRESIDENT)
- **Authorized official phone:** (601) 927-9839

## Contact information

- **Practice address:** 2073 HIGHWAY 49 S, FLORENCE, MS 39073-9422
- **Practice address phone:** (601) 845-3544
- **Practice address fax:** (601) 845-3636
- **Mailing address:** PO BOX 1522, FLORENCE, MS 39073-1522

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 3336C0003X | Community/Retail Pharmacy | 06939011 | MS | — |
| 3336I0012X | Institutional Pharmacy | — | NULL | — |
| 3336L0003X | Long Term Care Pharmacy | — | NULL | Yes |

## Other

- **Enumeration date:** 08/10/2006
- **Last updated:** 09/11/2025

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 2586622 | OTHER ID NUMBER-COMMERCIAL NUMBER | — |