Organization
BRICK CITY COMPOUNDING LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
EDWARD MUSSHAFEN PHARMD (PHARMACIST-IN-CHARGE)
(769) 231-1400
Entity
Organization
Contact information
Practice address
159 FOUNTAINS BLVD STE C, MADISON, MS 39110-6344
(769) 231-1400
(800) 958-5257
Mailing address
159 FOUNTAINS BLVD STE C, MADISON, MS 39110-6344
(769) 231-1400
(601) 859-8201
Taxonomy
Speciality
Code
Description
License number
State
3336C0004X
Compounding Pharmacy
Primary
—
—
Other
Enumeration date
08/10/2020
Last updated
12/13/2021
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