Healthcare Provider Details

I. General information

NPI: 1699318253
Provider Name (Legal Business Name): MP SOUTHPARK PHARMACY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/25/2019
Last Update Date: 03/14/2025
Certification Date: 03/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

309 CHRURCH ST
STERLING CITY TX
76951
US

IV. Provider business mailing address

1804 HALL AVE
LITTLEFIELD TX
79339-5439
US

V. Phone/Fax

Practice location:
  • Phone: 325-378-1147
  • Fax: 325-378-1149
Mailing address:
  • Phone: 325-378-1147
  • Fax: 325-378-1149

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: JENNIFER D WHITE
Title or Position: FINANCE MANAGER
Credential:
Phone: 325-655-3146