MKB PHARMACY, INC (NPI# 1821190463) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1821190463 |
| Entity Type | Organization |
| Organization Name | MKB PHARMACY, INC |
| Other Organization Name | TD PHARMACY |
| Practice Address |
12372 Highway 49 Gulfport MS 39503-2741 |
| Practice Telephone | 2288321414 |
| Practice Fax Number | 2288321479 |
| Mailing Telephone | 2288321414 |
| Mailing Fax Number | 2288321479 |
| Enumeration Date | 2006-09-03 |
| Last Update Date | 2020-10-27 |
| Authorized Official Name | STEPHEN FRANCIS PISARICH (PRESIDENT) |
| Authorized Official Telephone | 2288321414 |
| Authorized Official Credential | PHARM.D. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 3336C0003X |
Pharmacy Specialization: Community/Retail Pharmacy |
02829/01.1 | MS | Suppliers |
| Y | 3336C0003X |
Pharmacy Specialization: Community/Retail Pharmacy |
Suppliers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MS | 00330221 | 05 | |
| MS | NCPDP/NABP NUMBER | 2508577 | 01 |
| DEA LICENSE | FT9562085 | 01 | |
| MS | BOARD OF PHARMACY PERMIT | 18124 | 01 |
| Other Name | Type Code |
|---|---|
| TD Pharmacy | Doing Business As Name - Organization |
| Street Address |
12372 HIGHWAY 49 |
| City | GULFPORT |
| State | MS |
| Zip Code | 39503-2741 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1295397248 | Sgsp, Inc | Pharmacy | 12372 Highway 49, Gulfport, MS 39503-2741 | 2019-06-30 |
| 1568922847 | Mixon Drug Company, LLC | Pharmacy | 12372 Highway 49, Gulfport, MS 39503-2741 | 2019-03-22 |
| 1821373283 | Stephen Pisarich | Pharmacist | 12372 Highway 49, Gulfport, MS 39503-2741 | 2011-10-18 |
| 1477643765 | Day Drug Co Inc | Durable Medical Equipment & Medical Supplies | 12372 Highway 49, Gulfport, MS 39503-2741 | 2006-10-15 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1013515451 | Gulf Coast Neurospa, LLC | Psychiatry & Neurology | 8845 Lorraine Road, Gulfport, MS 39503 | 2020-10-16 |
| 1447865985 | Nicholas Wyrosdick | Physical Therapist | 12261 Us 49 #1, Gulfport, MS 39503 | 2020-09-11 |
| 1750935169 | Ladner Roy Drugs, LLC. | Pharmacy | 12261 Us 49 Suite 16, Gulfport, MS 39503 | 2019-07-25 |
| 1528559440 | Alexander Therapy Services, LLC | Clinic/Center | 15465 Oak Ln Ste 100c, Gulfport, MS 39503 | 2018-05-25 |
| 1750879003 | Heather Lynn Theisen | Nurse Practitioner | 15190 Community Rd Ste 330, Gulfport, MS 39503 | 2018-04-23 |
| 1083101216 | Gulf Coast Mental Health Center | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 15094 County Barn Road, Gulfport, MS 39503 | 2018-04-13 |
| 1306343173 | Dr. Raymond Monsour Scurfield, LLC | Community/Behavioral Health | 15465 Oak Lane Ste 100-g, Gulfport, MS 39503 | 2018-04-09 |
| 1952817157 | Mary Beth Welch | Behavioral Analyst | 9230 Old Lorraine Rd, Gulfport, MS 39503 | 2017-12-26 |
| 1831603257 | Beach View Family Dental, Pllc | Dentist | 9072 Lorraine Road, Gulfport, MS 39503 | 2017-11-21 |
| 1437677721 | Mary Stephens Ruffin | Social Worker | 11262 Creek Dr, Gulfport, MS 39503 | 2017-09-07 |
| Find all providers in zip 39503 | ||||
| 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] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1750935169 | Ladner Roy Drugs, LLC. | Pharmacy | 12261 Us 49 Suite 16, Gulfport, MS 39503 | 2019-07-25 |
| 1124506498 | Kanif Group LLC | Pharmacy | 2709 25th Avenue, Units C&d, Gulfport, MS 39501-4834 | 2018-07-30 |
| 1124576079 | G Med II LLC | Pharmacy | 4723 Tennessee Ave, Gulfport, MS 39501-8130 | 2016-09-20 |
| 1134583305 | Coastal Family Health Center Inc | Pharmacy | 9113 Highway 49 Ste 200, Gulfport, MS 39503-4330 | 2016-04-13 |
| 1730598293 | Skp LLC | Pharmacy | 5004 Gulfport Blvd S, Gulfport, FL 33707-4942 | 2014-08-09 |
| 1134568942 | Good Medicine, LLC | Pharmacy | 20006 Highway 53 Ste B, Gulfport, MS 39503-7843 | 2013-06-14 |
| 1952400269 | Mississippi Cvs Pharmacy, L.L.C. | Pharmacy | 2424 25th Ave, Gulfport, MS 39501-4524 | 2006-09-22 |
| 1861591174 | Mississippi Cvs Pharmacy, L.L.C. | Pharmacy | 1422 E Pass Rd, Gulfport, MS 39507-3521 | 2006-09-22 |
| 1134228448 | Mississippi Cvs Pharmacy, L.L.C. | Pharmacy | 11022 Highway 49, Gulfport, MS 39503-4110 | 2006-09-22 |
| 1295397248 | Sgsp, Inc | Pharmacy | 12372 Highway 49, Gulfport, MS 39503-2741 | 2019-06-30 |
| Find all providers in GULFPORT | ||||
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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.