# MIDSOUTH MEDICAL SPECIALTIES LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Super Drug
- **Organization subpart:** No

## Provider details

- **NPI number:** 1487806121
- **Authorized official:** SUPER DRUGS RPH (OWNER)
- **Authorized official phone:** (662) 280-7455

## Contact information

- **Practice address:** 1433 GOODMAN RD W, HORN LAKE, MS 38637
- **Practice address phone:** (662) 280-7455
- **Practice address fax:** (662) 280-7457
- **Mailing address:** PO BOX 563, HERNANDO, MS 38632-0563
- **Mailing address phone:** (662) 280-7455
- **Mailing address fax:** (662) 280-7457

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 3336C0003X | Community/Retail Pharmacy | — | NULL | Yes |
| 3336C0004X | Compounding Pharmacy | — | NULL | — |
| 3336S0011X | Specialty Pharmacy | — | NULL | — |

## Other

- **Enumeration date:** 10/14/2008
- **Last updated:** 01/08/2024