Organization
MIDSOUTH MEDICAL SPECIALTIES, LLC
Active
Parent organization
MIDSOUTH MEDICAL SPECIALTIES, LLC
Other names
Super Drugs
Organization subpart
Yes
Provider details
NPI number
Legal business name
MIDSOUTH MEDICAL SPECIALTIES, LLC
Authorized official
EDDIE O'BANNON (OWNER)
(901) 262-4317
Entity
Organization
Contact information
Practice address
5500 CENTRAL AVENUE, HOT SPRINGS, AR 71913
(014) 639-9225
(501) 463-9925
Mailing address
PO BOX 563, HERNANDO, MS 38632-0563
(501) 463-9922
(501) 463-9925
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
—
—
3336C0004X
Compounding Pharmacy
—
—
3336L0003X
Long Term Care Pharmacy
—
—
3336S0011X
Specialty Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
208246407
—
AR
Enumeration date
05/20/2014
Last updated
07/06/2020
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