=====================================================
General NPI Number Information
=====================================================
NPI Number | 1912615402
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SERVICE DRUGS LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/14/2022
-----------------------------------------------------
Last Update Date | 10/12/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 680 HIGHWAY 51
-----------------------------------------------------
City | RIDGELAND
-----------------------------------------------------
State | MS
-----------------------------------------------------
Zip | 39157-2103
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 601-853-4611
-----------------------------------------------------
Fax | 601-853-0521
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 195 E PEACE ST
-----------------------------------------------------
City | CANTON
-----------------------------------------------------
State | MS
-----------------------------------------------------
Zip | 39046-4519
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 601-859-3939
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/MEMBER
-----------------------------------------------------
Name | MR. MICHAEL CARL MURPHY
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 601-209-6314
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3336C0004X
-----------------------------------------------------
Taxonomy Name | Compounding Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 3336L0003X
-----------------------------------------------------
Taxonomy Name | Long Term Care Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------