Organization
APS PHARMACY 801 LLC
Active
Other names
APS Pharmacy #801, LLC
Organization subpart
No
Provider details
NPI number
Authorized official
MARK BRADFORD (PRESIDENT)
(662) 536-0384
Entity
Organization
Contact information
Practice address
480 AIRPORT INDUSTRIAL DR, SOUTHAVEN, MS 38671-5870
(662) 536-0384
(662) 536-4207
Mailing address
480 AIRPORT INDUSTRIAL DR, SOUTHAVEN, MS 38671-5870
(662) 536-0384
(662) 536-4207
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
—
—
3336L0003X
Long Term Care Pharmacy
Primary
0595626
MS
3336S0011X
Specialty Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
05908836
—
MS
01
—
2120958
PK
—
Enumeration date
05/18/2006
Last updated
07/11/2014
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