Healthcare Provider Details

I. General information

NPI: 1417900291
Provider Name (Legal Business Name): ROCKY L MCGARITY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/19/2006
Last Update Date: 05/12/2023
Certification Date: 05/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

103 W FRONTAGE RD SUITE A
LUCEDALE MS
39452-5836
US

IV. Provider business mailing address

103 W FRONTAGE RD SUITE A
LUCEDALE MS
39452-5836
US

V. Phone/Fax

Practice location:
  • Phone: 601-947-4941
  • Fax: 601-766-3010
Mailing address:
  • Phone: 601-947-4941
  • Fax: 601-766-3010

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number01104/1.1
License Number StateMS

VIII. Authorized Official

Name: ROCKY MCGARITY
Title or Position: OWNER
Credential: RPH
Phone: 601-947-4941