Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days.
Organization
MAGIC MART PHARMACY,INC
Active
Organization
MAGIC MART PHARMACY,INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GUY M MALONE (PRESIDENT)
(662) 887-4135
Entity
Organization
Contact information
Practice address
903 HIGHWAY 82 E BLDG G, INDIANOLA, MS 38751-2325
(662) 887-4135
(662) 887-9703
Mailing address
903 HIGHWAY 82 E BLDG G, INDIANOLA, MS 38751-2325
(662) 887-4135
(662) 887-9703
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
Primary
01301
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00330007
—
MS
01
—
00440170
MEDICAID DME
MS
01
—
0966510001
MEDICARE DME
MS
01
—
2517324
NCPDP
MS
Enumeration date
11/04/2006
Last updated
12/19/2019
About Stedi
Stedi is the only programmable healthcare clearinghouse. You can use Stedi's APIs to process eligibility checks, claims, remits, and more.
Sign up