Healthcare Provider Details

I. General information

NPI: 1689915423
Provider Name (Legal Business Name): REGION IV DESOTO COUNTY PHARMACY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/04/2013
Last Update Date: 06/06/2025
Certification Date: 06/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2705 HIGHWAY 51 S
HERNANDO MS
38632-2634
US

IV. Provider business mailing address

2705 HIGHWAY 51 S
HERNANDO MS
38632-2634
US

V. Phone/Fax

Practice location:
  • Phone: 662-449-4025
  • Fax: 662-429-3546
Mailing address:
  • Phone: 662-286-9883
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336C0002X
TaxonomyClinic Pharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: JASON RAMEY
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 662-286-9883