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General NPI Number Information
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NPI Number | 1184919268
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Entity Type | Organization
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Legal Business Name | FIRST PHARMACY SERVICES 5
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Dates
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Enumeration Date | 06/16/2011
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Last Update Date | 04/05/2022
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Provider Practice Location Address
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Address Line | 6888 GOODMAN RD STE 122
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City | OLIVE BRANCH
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State | MS
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Zip | 38654-8761
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Country | US
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Telephone | 662-349-3300
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Fax | 662-349-3311
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Provider Business Mailing Address
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Address Line | PO BOX 47
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City | POPE
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State | MS
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Zip | 38658-0047
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Country | US
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Telephone | 662-349-3300
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Fax | 662-349-3311
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Authorized Official
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Title or Position | VICE PRESIDENT
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Name | DENISE PRATT
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Credential |
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Telephone | 662-349-3300
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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 | 3336C0002X
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Taxonomy Name | Clinic Pharmacy
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 3336M0003X
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Taxonomy Name | Managed Care Organization Pharmacy
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 3336S0011X
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Taxonomy Name | Specialty Pharmacy
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 3336L0003X
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Taxonomy Name | Long Term Care Pharmacy
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License Number | 13864/4.1
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License Number State | MS
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