# MADISON MEDICAL COMPOUNDING PHARMACY

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1912488198
- **Authorized official:** KRISTEN LEANN CHAMBERS PHARM.D. (OPERATIONS MANAGER)
- **Authorized official phone:** (662) 820-4305

## Contact information

- **Practice address:** 117 FOUNTAINS BLVD STE 2, MADISON, MS 39110-6317
- **Practice address phone:** (601) 707-7545
- **Mailing address:** 117 FOUNTAINS BLVD STE 2, MADISON, MS 39110-6317
- **Mailing address phone:** (601) 707-7545

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1835P0018X | Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist | 17118 | MS | Yes |
| 3336S0011X | Specialty Pharmacy | 17118 | MS | — |

## Other

- **Enumeration date:** 08/24/2018
- **Last updated:** 09/23/2026