Organization
MKB PHARMACY, INC
Active
Other names
TD Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
STEPHEN FRANCIS PISARICH PHARM.D. (PRESIDENT)
(228) 832-1414
Entity
Organization
Contact information
Practice address
12372 HIGHWAY 49, GULFPORT, MS 39503-2741
(228) 832-1414
(228) 832-1479
Mailing address
12372 HIGHWAY 49, GULFPORT, MS 39503-2741
(228) 832-1414
(228) 832-1479
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
02829/01.1
MS
3336C0003X
Community/Retail Pharmacy
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00330221
—
MS
01
—
18124
BOARD OF PHARMACY PERMIT
MS
01
—
2508577
NCPDP/NABP NUMBER
MS
Enumeration date
09/03/2006
Last updated
03/07/2023
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