Healthcare Provider Details

I. General information

NPI: 1225378946
Provider Name (Legal Business Name): MEDISEND SPECIALTY PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/15/2013
Last Update Date: 04/10/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

127 PRATT DR
CORINTH MS
38834-6026
US

IV. Provider business mailing address

127 PRATT DR
CORINTH MS
38834-6026
US

V. Phone/Fax

Practice location:
  • Phone: 662-287-6405
  • Fax: 662-286-5898
Mailing address:
  • Phone: 662-287-6405
  • Fax: 662-286-5898

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number12105
License Number StateMS

VIII. Authorized Official

Name: DONALD KING
Title or Position: OWNER
Credential:
Phone: 662-293-0220