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Organization
MIDSOUTH MEDICAL SPECIALTIES LLC
Active
Organization
MIDSOUTH MEDICAL SPECIALTIES LLC
Active
Other names
Super Drug
Organization subpart
No
Provider details
NPI number
Authorized official
SUPER DRUGS RPH (OWNER)
(662) 280-7455
Entity
Organization
Contact information
Practice address
1433 GOODMAN RD W, HORN LAKE, MS 38637
(662) 280-7455
(662) 280-7457
Mailing address
PO BOX 563, HERNANDO, MS 38632-0563
(662) 280-7455
(662) 280-7457
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
—
NULL
3336C0004X
Compounding Pharmacy
—
NULL
3336S0011X
Specialty Pharmacy
—
NULL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02434788
—
MS
05
—
1534074
—
TN
01
—
2117404
PK
—
Enumeration date
10/14/2008
Last updated
01/08/2024
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