MIDSOUTH MEDICAL SPECIALTIES LLC (NPI# 1487806121) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1487806121 |
| Entity Type | Organization |
| Organization Name | MIDSOUTH MEDICAL SPECIALTIES LLC |
| Other Organization Name | SUPER DRUGS |
| Practice Address |
1433 Goodman Rd W Horn Lake MS 38637 |
| Mailing Address |
Po Box 563 Hernando MS 38632-0563 |
| Practice Telephone | 6622807455 |
| Practice Fax Number | 6622807457 |
| Mailing Telephone | 6622807455 |
| Mailing Fax Number | 6622807457 |
| Enumeration Date | 2008-10-14 |
| Last Update Date | 2020-07-06 |
| Authorized Official Name | EDDIE O'BANNON (OWNER) |
| Authorized Official Telephone | 9012624317 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 3336C0004X |
Pharmacy Specialization: Compounding Pharmacy |
Suppliers | ||
| N | 3336S0011X |
Pharmacy Specialization: Specialty Pharmacy |
Suppliers | ||
| Y | 3336C0003X |
Pharmacy Specialization: Community/Retail Pharmacy |
Suppliers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| PK | 2117404 | 01 | |
| TN | 1534074 | 05 | |
| MS | 02434788 | 05 |
| Other Name | Type Code |
|---|---|
| Super Drugs | Doing Business As Name - Organization |
| Street Address |
1433 GOODMAN RD W |
| City | HORN LAKE |
| State | MS |
| Zip Code | 38637 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1578011102 | Helen Joe | Pharmacist | 1433 Goodman Rd W, Horn Lake, MS 38637-1404 | 2016-09-12 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1184098733 | Wal-mart Stores East, Lp | Technician/Technologist | 4150 Goodman Road West, Horn Lake, MS 38637 | 2015-11-19 |
| 1609116581 | Horn Lake Eyecare Pllc | Optometrist | 2085 Goodman Rd, Horn Lake, MS 38637 | 2013-02-28 |
| 1356417992 | William E Middleton Jr Dds Pa | Dentist | 3011 Goodman Road W, Horn Lake, MS 38637 | 2006-11-27 |
| 1104297753 | Wal-mart Stores East Lp | Durable Medical Equipment & Medical Supplies | 4150 Goodman Rd, Horn Lake, MS 38637-0300 | 2015-10-08 |
| 1134617178 | Connie Irene Worley | Pharmacist | 4150 Goodman Rd, Horn Lake, MS 38637-0300 | 2018-04-25 |
| 1598252710 | Justin Mathis | Pharmacist | 4150 Goodman Rd, Horn Lake, MS 38637-0300 | 2018-04-13 |
| 1730686932 | Bradley Thomas Loeffel | Pharmacist | 4150 Goodman Rd, Horn Lake, MS 38637-0300 | 2018-04-12 |
| 1437759388 | Sarah Walls | Private Vehicle | 3765 Hilltop Dr, Horn Lake, MS 38637-1030 | 2020-10-29 |
| 1497901417 | William E. Middleton Jr. | Dentist | 3011 Goodman Rd W, Horn Lake, MS 38637-1103 | 2008-08-10 |
| 1114387768 | Jennifer Hailey-dukes | Physical Therapy Assistant | 3353 Country Side Cir Apt 47, Horn Lake, MS 38637-1171 | 2016-02-24 |
| Find all providers in zip 38637 | ||||
| Taxonomy Code | 3336C0003X |
| Grouping | Suppliers |
| Classification | Pharmacy |
| Specialization | Community/Retail Pharmacy |
| A pharmacy where pharmacists store, prepare, and dispense medicinal preparations and/or prescriptions for a local patient population in accordance with federal and state law; counsel patients and caregivers (sometimes independent of the dispensing process); administer vaccinations; and provide other professional services associated with pharmaceutical care such as health screenings, consultative services with other health care providers, collaborative practice, disease state management, and education classes. |
| Notes: Source: Developed by National Council for Prescription Drug Programs (NCPDP), National Home Infusion Association (NHIA), and Pharmacist Services Technical Advisory Coalition (PSTAC) [1/1/2006: new] |
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| 1649883844 | Natchez Wellness Pharmacy | Pharmacy | 29 Sergeant Prentiss Dr Ste 5, Natchez, MS 39120-4743 | 2020-08-26 |
| 1952910366 | Ct Stamps Inc | Pharmacy | 206 Marion Avenue, Mccomb, MS 39648 | 2020-07-31 |
| 1114566122 | Valley Drugs, Inc. | Pharmacy | 327b S Main St, Water Valley, MS 38965-3318 | 2019-12-23 |
| 1851939318 | Smith Pharmacy, Inc. | Pharmacy | 306 Northside Drive, Newton, MS 39345 | 2019-12-16 |
| 1285270801 | Proxsys Rx - Rush LLC | Pharmacy | 14916 Hwy 16 W, Unit #1, Dekalb, MS 39328 | 2019-11-19 |
| 1518501592 | Southwest Pharmacy Inc | Pharmacy | 3000 Plaza Dr Ste B, Tylertown, MS 39667-9227 | 2019-11-01 |
| 1669015210 | Hometown Family Pharmacy, Inc. | Pharmacy | 930 Hall St Ste H, Wiggins, MS 39577-2113 | 2019-10-25 |
| 1225671001 | A & A Infusion & Specialty, LLC | Pharmacy | 124 E Jackson St, Belzoni, MS 39038-3642 | 2019-10-23 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.