Organization
SOUTH MISSISSIPPI PHARMACISTS
Active
Other names
Park Place Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
BRENT LINDLEY PHARM.D. (OWNER)
(601) 450-3673
Entity
Organization
Contact information
Practice address
46 PARKWAY LN, PETAL, MS 39465-3035
(601) 450-3673
(888) 959-2285
Mailing address
46 PARKWAY LN, PETAL, MS 39465-3035
(601) 450-3673
(888) 959-2285
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
090361.1
MS
3336C0004X
Compounding Pharmacy
—
—
3336L0003X
Long Term Care Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
07904554
—
MS
01
—
2131489
PK
—
Enumeration date
06/07/2011
Last updated
07/16/2019
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