Organization
PHARMEDIUM SERVICES LLC
Active
Other names
Pharmedium Services LLC
Organization subpart
No
Provider details
NPI number
Authorized official
GARY GRIFFIN (RPH IN CHARGE)
(662) 846-5969
Entity
Organization
Contact information
Practice address
913 N DAVIS AVE, CLEVELAND, MS 38732-2106
(662) 846-5969
(662) 864-2614
Mailing address
913 N DAVIS AVE, CLEVELAND, MS 38732-2106
(662) 846-5969
(662) 864-2614
Taxonomy
Speciality
Code
Description
License number
State
3336C0004X
Compounding Pharmacy
Primary
05336/02.0
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2587357
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
09/29/2008
Last updated
06/22/2010
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