Organization
MAGNOLIA SPECIALTY PHARMACY INC
Active
Other names
Magnolia Specialty Pharmacy Inc.
Organization subpart
No
Provider details
NPI number
Authorized official
DAVID PARKER (PRESIDENT/OWNER)
(601) 606-0252
Entity
Organization
Contact information
Practice address
16 KEYSTONE DR STE B, HATTIESBURG, MS 39402-6121
(877) 871-3935
(888) 990-0575
Mailing address
16 KEYSTONE DR STE B, HATTIESBURG, MS 39402-6121
(877) 871-3935
(888) 990-0575
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
09087
MS
3336C0004X
Compounding Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2131699
PK
—
Enumeration date
08/24/2011
Last updated
04/11/2017
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