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General NPI Number Information
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NPI Number | 1912452921
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Entity Type | Organization
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Legal Business Name | SPORTS MEDICINE PHARMACY LLC
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Dates
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Enumeration Date | 08/19/2016
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Last Update Date | 10/23/2025
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Provider Practice Location Address
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Address Line | 4506 LAKELAND DR
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City | FLOWOOD
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State | MS
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Zip | 39232-9583
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Country | US
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Telephone | 601-949-9105
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Fax | 601-351-5974
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Provider Business Mailing Address
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Address Line | 4506 LAKELAND DR
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City | FLOWOOD
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State | MS
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Zip | 39232-9583
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Country | US
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Telephone | 601-949-9105
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Fax | 601-351-5974
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Authorized Official
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Title or Position | DIRECTOR OF PHARMACY SERVICES
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Name | DR. CHRISTOPHER GREGORY MCLAURIN
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Credential |
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Telephone | 601-949-9105
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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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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 | 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 #4
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number | 14908
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License Number State | MS
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