MEDICARE: MISSISSIPPI PHARMACEUTICAL SERVICES, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332BX2000X	Oxygen Equipment & Supplies (DME)	05055/11.1	MS
2	332B00000X	Durable Medical Equipment & Medical Supplies

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1356332183
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MISSISSIPPI PHARMACEUTICAL SERVICES, LLC

Provider Business Mailing Address
First Line	:	807 HIGHWAY 98 BYP
Second Line	:
City	:	COLUMBIA
State	:	MS
Zip	:	39429-3710
Country	:	US
Telephone Number	:	601-736-0843
Fax Number	:	601-736-0845

Provider Business Practice Location Address
First Line	:	807 HIGHWAY 98 BYP
Second Line	:
City	:	COLUMBIA
State	:	MS
Zip	:	39429-3710
Country	:	US
Telephone Number	:	601-736-0843
Fax Number	:	601-736-0845

Authorized Official
Title or Position	:	OWNER/PRESIDENT
Name	:	MRS. KIM A PATTERSON
Credential	:	RN
Telephone Number	:	601-736-0843

Provider Enumeration Date	:	11/01/2005
Last Update Date	:	12/27/2022

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Directions to “MISSISSIPPI PHARMACEUTICAL SERVICES, LLC ” Practice Location

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