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General NPI Number Information
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NPI Number | 1215349667
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Entity Type | Organization
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Legal Business Name | MIDSOUTH MEDICAL SPECIALTIES, LLC
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Dates
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Enumeration Date | 05/20/2014
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Last Update Date | 07/06/2020
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Provider Practice Location Address
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Address Line | 5500 CENTRAL AVENUE
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City | HOT SPRINGS
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State | AR
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Zip | 71913
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Country | US
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Telephone | 14-639-9225
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Fax | 501-463-9925
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Provider Business Mailing Address
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Address Line | PO BOX 563
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City | HERNANDO
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State | MS
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Zip | 38632-0563
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Country | US
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Telephone | 501-463-9922
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Fax | 501-463-9925
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Authorized Official
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Title or Position | OWNER
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Name | EDDIE O'BANNON
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Credential |
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Telephone | 901-262-4317
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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Taxonomy #2
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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 #3
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Taxonomy Code | 3336C0004X
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Taxonomy Name | Compounding 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 | 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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