Healthcare Provider Details

I. General information

NPI: 1912452921
Provider Name (Legal Business Name): SPORTS MEDICINE PHARMACY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/19/2016
Last Update Date: 10/23/2025
Certification Date: 10/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4506 LAKELAND DR
FLOWOOD MS
39232-9583
US

IV. Provider business mailing address

4506 LAKELAND DR
FLOWOOD MS
39232-9583
US

V. Phone/Fax

Practice location:
  • Phone: 601-949-9105
  • Fax: 601-351-5974
Mailing address:
  • Phone: 601-949-9105
  • Fax: 601-351-5974

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number14908
License Number StateMS
# 2
Primary TaxonomyN
Taxonomy Code3336C0002X
TaxonomyClinic Pharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: DR. CHRISTOPHER GREGORY MCLAURIN
Title or Position: DIRECTOR OF PHARMACY SERVICES
Credential:
Phone: 601-949-9105