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General NPI Number Information
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NPI Number | 1669961405
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Entity Type | Organization
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Legal Business Name | SPECIALIZED CLINICAL PHARMACY, LLC
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Dates
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Enumeration Date | 05/08/2018
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Last Update Date | 05/25/2021
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Provider Practice Location Address
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Address Line | 1194 S 18TH STREET EXT
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City | OXFORD
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State | MS
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Zip | 38655-5378
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Country | US
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Telephone | 662-281-0000
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Fax | 662-281-0003
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Provider Business Mailing Address
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Address Line | 1194 S 18TH STREET EXT
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City | OXFORD
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State | MS
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Zip | 38655-5378
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Country | US
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Telephone | 662-281-0000
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Fax | 662-281-0003
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Authorized Official
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Title or Position | PHARMACIST IN CHARGE
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Name | MR. ANTHONY ALAN ASHBROOK
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Credential | RPH
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Telephone | 662-281-0000
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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 | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 16761
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License Number State | MS
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