Organization
MIDSOUTH MEDICAL SPECIALTIES, LLC
Active
Other names
Grace Apothecary
Organization subpart
No
Provider details
NPI number
Authorized official
EDDIE D O'BANNON PHARM D (OWNER)
(901) 262-4317
Entity
Organization
Contact information
Practice address
185 W CENTER ST, HERNANDO, MS 38632-2268
(901) 262-4317
(662) 510-0268
Mailing address
PO BOX 563, HERNANDO, MS 38632-0563
(901) 262-4317
(662) 510-0268
Taxonomy
Speciality
Code
Description
License number
State
3336C0004X
Compounding Pharmacy
Primary
—
—
Other
Enumeration date
08/28/2013
Last updated
08/28/2013
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