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General NPI Number Information
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NPI Number | 1770127250
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Entity Type | Organization
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Legal Business Name | MP SOUTHPARK PHARMACY LLC
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Dates
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Enumeration Date | 10/29/2019
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Last Update Date | 03/11/2025
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Provider Practice Location Address
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Address Line | 104 E SAN SABA ST
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City | MENARD
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State | TX
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Zip | 76859-2709
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Country | US
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Telephone | 325-396-2480
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Fax |
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Provider Business Mailing Address
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Address Line | 1804 HALL AVE
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City | LITTLEFIELD
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State | TX
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Zip | 79339-5439
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Country | US
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Telephone | 325-655-2821
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Fax |
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Authorized Official
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Title or Position | FINANCE MANAGER
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Name | JENNIFER D WHITE
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Credential |
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Telephone | 325-655-3146
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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