Healthcare Provider Details

I. General information

NPI: 1063710820
Provider Name (Legal Business Name): SALTILLO PHARMACY SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/03/2011
Last Update Date: 06/22/2023
Certification Date: 06/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2698 HIGHWAY 145
SALTILLO MS
38866-6941
US

IV. Provider business mailing address

138 COURTLAND DRIVE
SALTILLO MS
38866
US

V. Phone/Fax

Practice location:
  • Phone: 662-269-2781
  • Fax: 662-269-2037
Mailing address:
  • Phone: 662-279-0599
  • Fax: 662-269-2037

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: MR. TIMOTHY LEE GRIFFIN
Title or Position: PHARMACIST, OWNER
Credential: PHARMD
Phone: 662-279-0599