Healthcare Provider Details

I. General information

NPI: 1467511196
Provider Name (Legal Business Name): PHARMACY INVESTMENT GROUP, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/08/2006
Last Update Date: 04/04/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

330 EAST LEE ST.
SARDIS MS
38666
US

IV. Provider business mailing address

330 EAST LEE ST.
SARDIS MS
38666
US

V. Phone/Fax

Practice location:
  • Phone: 662-487-1224
  • Fax: 662-487-1235
Mailing address:
  • Phone: 662-487-1224
  • Fax: 662-487-1235

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number00946/1.1
License Number StateMS
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: MR. ERNEST W. RUCKER JR.
Title or Position: DIRECTOR
Credential:
Phone: 662-487-1224