# VICKSBURG SPECIAL CARE PHARMACY AND COMPOUNDING LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Aspire Rx
- **Organization subpart:** No

## Provider details

- **NPI number:** 1659606663
- **Authorized official:** JASON RUTLAND PHARM D (MGR)
- **Authorized official phone:** (601) 983-1239

## Contact information

- **Practice address:** 4079 PEMBERTON SQUARE BLVD, VICKSBURG, MS 39180-5580
- **Practice address phone:** (601) 636-5555
- **Practice address fax:** (601) 638-1564
- **Mailing address:** 1485 LIVINGSTON LN, JACKSON, MS 39213-8004
- **Mailing address phone:** (601) 326-7347
- **Mailing address fax:** (601) 982-7103

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 333600000X | Pharmacy | — | NULL | — |
| 3336C0003X | Community/Retail Pharmacy | 08249/1.1 | MS | Yes |

## Other

- **Enumeration date:** 10/08/2009
- **Last updated:** 10/07/2016

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 123555 | — | LA |
| 01 | — | 2122108 | PK | — |