# MKB PHARMACY, INC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** TD Pharmacy
- **Organization subpart:** No

## Provider details

- **NPI number:** 1821190463
- **Authorized official:** STEPHEN FRANCIS PISARICH PHARM.D. (PRESIDENT)
- **Authorized official phone:** (228) 832-1414

## Contact information

- **Practice address:** 12372 HIGHWAY 49, GULFPORT, MS 39503-2741
- **Practice address phone:** (228) 832-1414
- **Practice address fax:** (228) 832-1479
- **Mailing address:** 12372 HIGHWAY 49, GULFPORT, MS 39503-2741
- **Mailing address phone:** (228) 832-1414
- **Mailing address fax:** (228) 832-1479

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 3336C0003X | Community/Retail Pharmacy | 02829/01.1 | MS | — |
| 3336C0003X | Community/Retail Pharmacy | — | NULL | Yes |

## Other

- **Enumeration date:** 09/03/2006
- **Last updated:** 03/07/2023

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 00330221 | — | MS |
| 01 | — | 18124 | BOARD OF PHARMACY PERMIT | MS |
| 01 | — | 2508577 | NCPDP/NABP NUMBER | MS |