Healthcare Provider Details

I. General information

NPI: 1043239031
Provider Name (Legal Business Name): IUKA PHARMACY SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/19/2006
Last Update Date: 09/10/2021
Certification Date: 09/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1411 W QUITMAN ST
IUKA MS
38852-1130
US

IV. Provider business mailing address

1411 W QUITMAN ST
IUKA MS
38852-1130
US

V. Phone/Fax

Practice location:
  • Phone: 662-423-9039
  • Fax: 662-423-9318
Mailing address:
  • Phone: 662-423-9039
  • Fax: 662-423-9318

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number00827011
License Number StateMS
# 2
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number00827011
License Number StateMS
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: MR. TIMOTHY LEE GRIFFIN
Title or Position: OWNER
Credential: PHARMD
Phone: 662-423-9039