Organization
PHARMAKEUS INC
Active
Other names
MARTYS PHARMACY AND COMPOUNDING CENTER
Organization subpart
No
Provider details
NPI number
Authorized official
RONNIE BAGWELL RPH (OWNER AND PRESIDENT)
(601) 932-2027
Entity
Organization
Contact information
Practice address
1042 RIVER OAKS DR, FLOWOOD, MS 39232-9594
(601) 932-2027
(601) 936-2166
Mailing address
1042 RIVER OAKS DR, FLOWOOD, MS 39232-9594
(601) 932-2027
(601) 936-2166
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
01771/1.1
MS
3336C0004X
Compounding Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00330225
—
MS
01
—
2044831
PK
—
Enumeration date
11/14/2006
Last updated
03/01/2017
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