Healthcare Provider Details

I. General information

NPI: 1356332183
Provider Name (Legal Business Name): MISSISSIPPI PHARMACEUTICAL SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2005
Last Update Date: 12/27/2022
Certification Date: 12/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

807 HIGHWAY 98 BYP
COLUMBIA MS
39429-3710
US

IV. Provider business mailing address

807 HIGHWAY 98 BYP
COLUMBIA MS
39429-3710
US

V. Phone/Fax

Practice location:
  • Phone: 601-736-0843
  • Fax: 601-736-0845
Mailing address:
  • Phone: 601-736-0843
  • Fax: 601-736-0845

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number05055/11.1
License Number StateMS
# 2
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: MRS. KIM A PATTERSON
Title or Position: OWNER/PRESIDENT
Credential: RN
Phone: 601-736-0843