# MS STATE DEPT OF HEALTH

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

## Provider details

- **NPI number:** 1376606582
- **Authorized official:** JULIA WOODS (PHARMACIST)
- **Authorized official phone:** (601) 713-3457

## Contact information

- **Practice address:** 3156 LAWSON STREET, JACKSON, MS 39213
- **Practice address phone:** (601) 713-3457
- **Practice address fax:** (601) 364-2670
- **Mailing address:** 3156 LAWSON STREET, JACKSON, MS 39213
- **Mailing address phone:** (601) 713-3457
- **Mailing address fax:** (601) 364-2670

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 251K00000X | Public Health or Welfare Agency | 01085 05.1 | MS | — |
| 3336C0002X | Clinic Pharmacy | 0108505.1 | MS | — |
| 3336L0003X | Long Term Care Pharmacy | — | NULL | Yes |

## Other

- **Enumeration date:** 12/18/2006
- **Last updated:** 10/22/2024

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 2517196 | NCPDP | — |