MEDICARE: BENEFICIAL PHARMACEUTICAL SUPPLY 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	3336L0003X	Long Term Care Pharmacy		MS

General Provider Information

NPI Number	:	1750318150
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BENEFICIAL PHARMACEUTICAL SUPPLY LLC

Provider Business Mailing Address
First Line	:	PO BOX 307
Second Line	:
City	:	SHERMAN
State	:	MS
Zip	:	38869-0307
Country	:	US
Telephone Number	:	662-842-8400
Fax Number	:	662-680-4700

Provider Business Practice Location Address
First Line	:	2445 MCCULLOUGH BLVD
Second Line	:
City	:	BELDEN
State	:	MS
Zip	:	38826
Country	:	US
Telephone Number	:	662-842-8400
Fax Number	:	662-680-4700

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. CHARLES L BOATNER JR.
Credential	:
Telephone Number	:	662-842-8400

Provider Enumeration Date	:	06/28/2006
Last Update Date	:	08/22/2020

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