Healthcare Provider Details

I. General information

NPI: 1437513876
Provider Name (Legal Business Name): THE TRANSPLANT PHARMACY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/12/2016
Last Update Date: 04/13/2022
Certification Date: 04/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

630 LAKELAND EAST DR STE B
FLOWOOD MS
39232-9565
US

IV. Provider business mailing address

630 LAKELAND EAST DR STE B
FLOWOOD MS
39232-9565
US

V. Phone/Fax

Practice location:
  • Phone: 769-230-8335
  • Fax: 769-230-8337
Mailing address:
  • Phone: 769-230-8335
  • Fax: 769-230-8337

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number StateMS

VIII. Authorized Official

Name: JAMES GULLEY
Title or Position: VICE PRESIDENT
Credential: PHARMD.
Phone: 769-230-8335