=====================================================
General NPI Number Information
=====================================================
NPI Number | 1073524583
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | EMMANUEL RIDGE COMM PHCY
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/10/2006
-----------------------------------------------------
Last Update Date | 09/11/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2073 HIGHWAY 49 S
-----------------------------------------------------
City | FLORENCE
-----------------------------------------------------
State | MS
-----------------------------------------------------
Zip | 39073-9422
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 601-845-3544
-----------------------------------------------------
Fax | 601-845-3636
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 1522
-----------------------------------------------------
City | FLORENCE
-----------------------------------------------------
State | MS
-----------------------------------------------------
Zip | 39073-1522
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | BEATRICE EZEM
-----------------------------------------------------
Credential | RN CM CLNC
-----------------------------------------------------
Telephone | 601-927-9839
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number | 06939011
-----------------------------------------------------
License Number State | MS
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 3336I0012X
-----------------------------------------------------
Taxonomy Name | Institutional Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 3336L0003X
-----------------------------------------------------
Taxonomy Name | Long Term Care Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------