Organization
MIDSOUTH MEDICAL SPECIALTIES LLC
Active
Other names
Super Drug
Organization subpart
No
Provider details
NPI number
Authorized official
SUPER DRUGS RPH (OWNER)
(662) 280-7455
Entity
Organization
Contact information
Practice address
1433 GOODMAN RD W, HORN LAKE, MS 38637
(662) 280-7455
(662) 280-7457
Mailing address
PO BOX 563, HERNANDO, MS 38632-0563
(662) 280-7455
(662) 280-7457
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
—
—
3336C0004X
Compounding Pharmacy
—
—
3336S0011X
Specialty Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02434788
—
MS
05
—
1534074
—
TN
01
—
2117404
PK
—
Enumeration date
10/14/2008
Last updated
01/08/2024
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