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Organization
MIDSOUTH MEDICAL SPECIALTIES, LLC
Active
Organization
MIDSOUTH MEDICAL SPECIALTIES, LLC
Active
Other names
Super Drugs #2
Organization subpart
No
Provider details
NPI number
Authorized official
MR. EDDIE O'BANNON (OWNER)
(662) 449-9075
Entity
Organization
Contact information
Practice address
2260 HIGHWAY 515 SOUTH, HERNANDO, MS 38632
(662) 449-9075
(662) 449-3414
Mailing address
2260 HIGHWAY 515 SOUTH, HERNANDO, MS 38632
(662) 449-9075
(662) 449-3414
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
11889
MS
Other
Enumeration date
12/26/2012
Last updated
12/26/2012
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