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General NPI Number Information
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NPI Number | 1063971539
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Entity Type | Organization
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Legal Business Name | NATIONAL PHARMACY OF MISSISSIPPI, LLC
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Dates
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Enumeration Date | 03/14/2019
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Last Update Date | 10/21/2019
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Provider Practice Location Address
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Address Line | 371B HIGHLAND COLONY PKWY
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City | RIDGELAND
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State | MS
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Zip | 39157-6035
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Country | US
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Telephone | 769-235-4141
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Fax | 769-235-7162
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Provider Business Mailing Address
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Address Line | 371B HIGHLAND COLONY PKWY
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City | RIDGELAND
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State | MS
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Zip | 39157-6035
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Country | US
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Telephone | 769-235-4141
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Fax | 769-235-7162
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | SAMUEL THOMAS MAHFOUZ
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Credential |
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Telephone | 769-235-4141
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3336L0003X
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Taxonomy Name | Long Term Care Pharmacy
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License Number |
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License Number State |
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