Healthcare Provider Details

I. General information

NPI: 1255342762
Provider Name (Legal Business Name): LTC PHARMACY SOLUTIONS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/10/2006
Last Update Date: 02/21/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2801 W MAIN ST
TUPELO MS
38801-3001
US

IV. Provider business mailing address

PO BOX 3308
TUPELO MS
38803-3308
US

V. Phone/Fax

Practice location:
  • Phone: 662-840-6411
  • Fax: 877-840-0456
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number0728023
License Number StateMS

VIII. Authorized Official

Name: MELINDA HYRE
Title or Position: DIRECTOR OF PHARMACY
Credential:
Phone: 662-840-6411