Healthcare Provider Details

I. General information

NPI: 1346279015
Provider Name (Legal Business Name): COMMUNITY HOME CARE PHARMACY INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/03/2006
Last Update Date: 06/19/2020
Certification Date: 06/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 HIGHWAY 11 N SUITE A
PICAYUNE MS
39466-3312
US

IV. Provider business mailing address

PO BOX 10
PICAYUNE MS
39466
US

V. Phone/Fax

Practice location:
  • Phone: 601-798-4830
  • Fax: 601-798-4825
Mailing address:
  • Phone: 601-798-4846
  • Fax: 601-798-4825

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number05766/02.0
License Number StateMS
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number05766/02.0
License Number StateMS
# 3
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number05766/02.0
License Number StateMS
# 4
Primary TaxonomyN
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License Number05766/02.0
License Number StateMS
# 5
Primary TaxonomyN
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number05766/02.0
License Number StateMS
# 6
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number05766/02.0
License Number StateMS
# 7
Primary TaxonomyN
Taxonomy Code3336H0001X
TaxonomyHome Infusion Therapy Pharmacy
License Number05766/02.0
License Number StateMS
# 8
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State
# 9
Primary TaxonomyN
Taxonomy Code3336M0002X
TaxonomyMail Order Pharmacy
License Number05766/02.0
License Number StateMS
# 10
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number05766/02.0
License Number StateMS
# 11
Primary TaxonomyY
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number05766/02.0
License Number StateMS

VIII. Authorized Official

Name: MR. ANDREW L. FAILLA
Title or Position: PRESIDENT
Credential: RPH
Phone: 601-798-4846