# MIDSOUTH MEDICAL SPECIALTIES, LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Super Drugs \#2
- **Organization subpart:** No

## Provider details

- **NPI number:** 1255677001
- **Authorized official:** MR. EDDIE O'BANNON (OWNER)
- **Authorized official phone:** (662) 449-9075

## Contact information

- **Practice address:** 2260 HIGHWAY 515 SOUTH, HERNANDO, MS 38632
- **Practice address phone:** (662) 449-9075
- **Practice address fax:** (662) 449-3414
- **Mailing address:** 2260 HIGHWAY 515 SOUTH, HERNANDO, MS 38632
- **Mailing address phone:** (662) 449-9075
- **Mailing address fax:** (662) 449-3414

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 3336C0003X | Community/Retail Pharmacy | 11889 | MS | Yes |

## Other

- **Enumeration date:** 12/26/2012
- **Last updated:** 12/26/2012