Healthcare Provider Details

I. General information

NPI: 1235175746
Provider Name (Legal Business Name): TRUSTMORE INCORPORATED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/22/2006
Last Update Date: 03/28/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 METROPLEX BLVD SUITE A
PEARL MS
39208
US

IV. Provider business mailing address

102 METROPLEX BLVD SUITE A
PEARL MS
39208
US

V. Phone/Fax

Practice location:
  • Phone: 601-502-2350
  • Fax: 601-502-2352
Mailing address:
  • Phone: 601-502-2350
  • Fax: 601-502-2352

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number06864026
License Number StateMS

VIII. Authorized Official

Name: MICHAEL KELLY
Title or Position: PRESIDENT
Credential:
Phone: 601-946-3939