Healthcare Provider Details

I. General information

NPI: 1225671001
Provider Name (Legal Business Name): A & A INFUSION & SPECIALTY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/23/2019
Last Update Date: 10/23/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

124 E JACKSON ST
BELZONI MS
39038-3642
US

IV. Provider business mailing address

2044 HIGHWAY 1 S
GREENVILLE MS
38701-7806
US

V. Phone/Fax

Practice location:
  • Phone: 662-332-0177
  • Fax: 662-537-4953
Mailing address:
  • Phone: 662-580-0020
  • Fax: 662-537-4953

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: ROBERT T STOKES
Title or Position: OWNER
Credential:
Phone: 662-580-0020