# MIDSOUTH MEDICAL SPECIALTIES LLC

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

## Provider details

- **NPI number:** 1932864667
- **Authorized official:** JAKE O'BANNON (PHARMACIST)
- **Authorized official phone:** (662) 280-7455

## Contact information

- **Practice address:** 1433 GOODMAN RD W, HORN LAKE, MS 38637-1404
- **Practice address phone:** (901) 674-3148
- **Mailing address:** 1433 GOODMAN RD W, HORN LAKE, MS 38637-1404
- **Mailing address phone:** (662) 280-7455

## Taxonomy

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

## Other

- **Enumeration date:** 11/08/2021
- **Last updated:** 11/08/2021