MEDICARE: CLEVELAND MEDICAL ARTS PHARMACY INC

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	3336C0003X	Community/Retail Pharmacy	13291/1.1	MS

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
2	2146708	OTHER		PK

General Provider Information

NPI Number	:	1730121336
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CLEVELAND MEDICAL ARTS PHARMACY INC

Provider Business Mailing Address
First Line	:	810 E SUNFLOWER RD STE 100D
Second Line	:
City	:	CLEVELAND
State	:	MS
Zip	:	38732-2828
Country	:	US
Telephone Number	:	662-843-4214
Fax Number	:	662-843-3398

Provider Business Practice Location Address
First Line	:	810 E SUNFLOWER RD STE 100D
Second Line	:
City	:	CLEVELAND
State	:	MS
Zip	:	38732-2828
Country	:	US
Telephone Number	:	662-843-4214
Fax Number	:	662-843-3398

Authorized Official
Title or Position	:	PRESIDENT
Name	:	GUY PHILLIPS
Credential	:
Telephone Number	:	662-207-0616

Provider Enumeration Date	:	06/11/2006
Last Update Date	:	01/30/2025

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