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Organization
VICKSBURG SPECIAL CARE PHARMACY AND COMPOUNDING LLC
Active
Organization
VICKSBURG SPECIAL CARE PHARMACY AND COMPOUNDING LLC
Active
Other names
Aspire Rx
Organization subpart
No
Provider details
NPI number
Authorized official
JASON RUTLAND PHARM D (MGR)
(601) 983-1239
Entity
Organization
Contact information
Practice address
4079 PEMBERTON SQUARE BLVD, VICKSBURG, MS 39180-5580
(601) 636-5555
(601) 638-1564
Mailing address
1485 LIVINGSTON LN, JACKSON, MS 39213-8004
(601) 326-7347
(601) 982-7103
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
NULL
3336C0003X
Community/Retail Pharmacy
Primary
08249/1.1
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
123555
—
LA
01
—
2122108
PK
—
Enumeration date
10/08/2009
Last updated
10/07/2016
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