MIDSOUTH MEDICAL SPECIALTIES, LLC (NPI# 1992139711) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1992139711 |
| Entity Type | Organization |
| Organization Name | MIDSOUTH MEDICAL SPECIALTIES, LLC |
| Other Organization Name | GRACE APOTHECARY |
| Practice Address |
185 W Center St Hernando MS 38632-2268 |
| Mailing Address |
Po Box 563 Hernando MS 38632-0563 |
| Practice Telephone | 9012624317 |
| Practice Fax Number | 6625100268 |
| Mailing Telephone | 9012624317 |
| Mailing Fax Number | 6625100268 |
| Enumeration Date | 2013-08-28 |
| Last Update Date | 2013-08-28 |
| Authorized Official Name | EDDIE D O'BANNON (OWNER) |
| Authorized Official Telephone | 9012624317 |
| Authorized Official Credential | PHARM D |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 3336C0004X |
Pharmacy Specialization: Compounding Pharmacy |
Suppliers |
| Other Name | Type Code |
|---|---|
| Grace Apothecary | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1558894790 | Midsouth Medical Specialties, LLC | Pharmacy | 105 Sawtooth Oak St, Hot Springs, AR 71901-7160 | 2017-04-05 |
| 1215349667 | Midsouth Medical Specialties, LLC | Pharmacy | 5500 Central Avenue, Hot Springs, AR 71913 | 2014-05-20 |
| 1255677001 | Midsouth Medical Specialties, LLC | Pharmacy | 2260 Highway 515 South, Hernando, MS 38632 | 2012-12-26 |
| 1215460688 | Midsouth Medical Specialties, LLC | Pharmacy | 1534 Malvern Ave, Hot Springs, AR 71901-6508 | 2017-04-04 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| New York State Corporations | MIDSOUTH MEDICAL SPECIALTIES, LLC | 200 Sterlin Lane, Hernando, Ms 38632 |
| Street Address |
185 W CENTER ST |
| City | HERNANDO |
| State | MS |
| Zip Code | 38632-2268 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1275042335 | Dominic Lashay Freeman | Case Management | 2744 Hwy 51 South, Hernando, MS 38632 | 2017-09-21 |
| 1851814875 | Staci Lea Hudson | Nurse Practitioner | 2705 Hwy 51 South, Hernando, MS 38632 | 2017-07-21 |
| 1629425517 | Jamieka Harris | Counselor | 2705 Hwy 51 S, Hernando, MS 38632 | 2016-05-20 |
| 1215302476 | Elizabeth Claire Corban | Counselor | 2725 Highway 51 S., Hernando, MS 38632 | 2015-12-14 |
| 1669850004 | Jcc, LLC | Dentist | 1150 Monteith Avenue, Suite 102, Hernando, MS 38632 | 2015-05-18 |
| 1053701995 | Leigh Houston | Registered Nurse | 3104 Stonehenge Dr, Hernando, MS 38632 | 2015-01-30 |
| 1871831552 | Hernando Dental Group Incorporated | Dentist | 2264 Mcingvale Rd., Hernando, MS 38632 | 2013-01-30 |
| 1255677001 | Midsouth Medical Specialties, LLC | Pharmacy | 2260 Highway 515 South, Hernando, MS 38632 | 2012-12-26 |
| 1447506514 | Surgical First Assist, LLC | Specialist/Technologist, Other | 8921 Black Panther Cove, Herenando, MS 38632 | 2012-07-26 |
| 1629348396 | Stacy Riddle-mattox | Counselor | 2725 Highway 51 South, Hernando, MS 38632 | 2012-01-11 |
| Find all providers in zip 38632 | ||||
| Taxonomy Code | 3336C0004X |
| Grouping | Suppliers |
| Classification | Pharmacy |
| Specialization | Compounding Pharmacy |
| A pharmacy that specializes in the preparation of components into a drug preparation as the result of a Practitioner’s Prescription Drug Order or initiative based on the Practitioner/Patient/Pharmacist relationship in the course of professional practice. A compounding pharmacy utilizes specialized equipment and specially designed facilities necessary to meet the legal and quality requirements of its scope of compounding practice. |
| Notes: Sources: NABP Model Practice Act, Appendix C - Good Compounding Practice, USP <795> and <797>, and Pharmacy Compounding Accreditation Board [7/1/2006: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1316558851 | Brick City Compounding LLC | Pharmacy | 159 Fountains Blvd Ste C, Madison, MS 39110-6344 | 2020-08-10 |
| 1164968624 | Saver Express LLC | Pharmacy | 1051 Highland Colony Pkwy Ste C, Ridgeland, MS 39157-7701 | 2017-01-09 |
| 1902359342 | Asm Inc | Pharmacy | 9065 Sandidge Center Cv, Suite A, Olive Branch, MS 38654-3574 | 2016-08-02 |
| 1538522446 | Kinetix Group LLC | Pharmacy | 104 Business Park Dr Ste H, Suite H, Ridgeland, MS 39157-6017 | 2016-03-30 |
| 1477968980 | Advantage Apothecary, LLCf | Pharmacy | 5296 Old Highway 11 Ste 4, Hattiesburg, MS 39402-8380 | 2014-06-23 |
| 1275951402 | Olde Towne Drugs, Ltd. | Pharmacy | 1645 W Government Cv Ste E, Brandon, MS 39042-4602 | 2014-04-04 |
| 1285987461 | Southwest Pharmacy Inc | Pharmacy | 1005 W Congress St, Brookhaven, MS 39601-2603 | 2012-10-24 |
| 1407109457 | Keystone Pharmacy LLC | Pharmacy | 106 Highland Way Ste 206, Madison, MS 39110-6930 | 2012-10-15 |
| 1851648836 | Pharmatex, LLC | Pharmacy | 4551-d Gautier Vancleave Road, Gautier, MS 39553 | 2012-08-09 |
| 1679833404 | Highland Specialty Pharmacy LLC | Pharmacy | 23 Town Center Square, Hattiesburg, MS 39402 | 2012-05-28 |
| 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.