Organization
VICKSBURG SPECIAL CARE PHARMACY AND COMPOUNDING LLC
Active
Other names
Aspire Rx
Organization subpart
No
Provider details
NPI number
Authorized official
JASON RUTLAND PHARM D (MGR)
(601) 983-1239
Entity
Organization
Contact information
Practice address
4079 PEMBERTON SQUARE BLVD, VICKSBURG, MS 39180-5580
(601) 636-5555
(601) 638-1564
Mailing address
1485 LIVINGSTON LN, JACKSON, MS 39213-8004
(601) 326-7347
(601) 982-7103
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
08249/1.1
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
123555
—
LA
01
—
2122108
PK
—
Enumeration date
10/08/2009
Last updated
10/07/2016
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