Healthcare Provider Details

I. General information

NPI: 1942345574
Provider Name (Legal Business Name): PHARMACY MANAGEMENT GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/21/2007
Last Update Date: 05/06/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

425 MAIN ST
COLUMBUS MS
39701-4533
US

IV. Provider business mailing address

425 MAIN ST
COLUMBUS MS
39701-4533
US

V. Phone/Fax

Practice location:
  • Phone: 662-328-1766
  • Fax: 662-328-9273
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number00363
License Number StateMS

VIII. Authorized Official

Name: RONALD HARRIS
Title or Position: PHRM OWNER
Credential: RPH
Phone: 662-327-4025