Healthcare Provider Details

I. General information

NPI: 1659448934
Provider Name (Legal Business Name): SPECIALTY SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/29/2006
Last Update Date: 07/12/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1627 HIGHWAY 61 JONESTOWN RD
COAHOMA MS
38617-9790
US

IV. Provider business mailing address

1627 HIGHWAY 61 JONESTOWN RD
COAHOMA MS
38617-9790
US

V. Phone/Fax

Practice location:
  • Phone: 662-358-4500
  • Fax: 662-358-4507
Mailing address:
  • Phone: 662-358-4500
  • Fax: 662-358-4507

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number04428/02.0
License Number StateMS
# 2
Primary TaxonomyN
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License Number04428/02.0
License Number StateMS
# 3
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License NumberOS01422
License Number StateAR
# 4
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number04428 02.0
License Number StateMS
# 5
Primary TaxonomyY
Taxonomy Code3336H0001X
TaxonomyHome Infusion Therapy Pharmacy
License Number04428 02.0
License Number StateMS

VIII. Authorized Official

Name: CAROL J WEILAND
Title or Position: OWNER PHARMACIST
Credential: PD
Phone: 662-358-4500