Healthcare Provider Details

I. General information

NPI: 1881064772
Provider Name (Legal Business Name): APPLE PHARMACEUTICALS & HEALTHCARE SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2015
Last Update Date: 10/05/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 RILEY DR
JACKSON MS
39209-2595
US

IV. Provider business mailing address

115 RILEY DR
JACKSON MS
39209-2595
US

V. Phone/Fax

Practice location:
  • Phone: 601-923-4200
  • Fax: 601-923-2771
Mailing address:
  • Phone: 601-923-4200
  • Fax: 601-923-2771

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number StateMS
# 2
Primary TaxonomyN
Taxonomy Code332100000X
TaxonomyDepartment of Veterans Affairs (VA) Pharmacy
License Number
License Number StateMS
# 3
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number StateMS
# 4
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number StateMS
# 5
Primary TaxonomyN
Taxonomy Code3336M0002X
TaxonomyMail Order Pharmacy
License Number
License Number StateMS
# 6
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number
License Number StateMS

VIII. Authorized Official

Name: MS. DE'SHAWN N GRAVES
Title or Position: OWNER
Credential: CPHT
Phone: 850-630-6072