Ellisville State School Pharmacy

LBN: Ellisville State School
Ellisville State School Pharmacy is an health care organization with primary practice located at 1101 Highway 11 S , Ellisville MS 39437-4443. The organization recently has 2 registered licenses in different health care specialties including Suppliers / Pharmacy, Suppliers / Long Term Care Pharmacy. Suppliers / Long Term Care Pharmacy is the primary health care specialty. Ellisville State School can be contacted via phone (601) 477-5785, or through Welch, Patti via phone (601) 477-5784.

Contact Information

Primary practice address
1101 Highway 11 S Ellisville MS 39437-4443
Phone: (601) 477-5785
Fax: (601) 477-5687
Website:
Map and Directions
Authorized official contact:
Name: Welch, Patti RPH
Phone: (601) 477-5784

Health care specialties

SpecialtyCodeLicense #State
Suppliers / Pharmacy 333600000X
Suppliers / Long Term Care Pharmacy 3336L0003X 01185031 Mississippi

Profile Details

NPI number 1578668901
LBN Legal business name Ellisville State School
DBA Doing business as Ellisville State School Pharmacy
Authorized official Welch, Patti RPH
Entity Organization
Organization subpart 1 No
Enumeration date Sep 13th, 2006
Last updated Dec 17th, 2019 - about 5 years ago

1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.

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Identifiers

StateTypeNumberIssuer
All States NPI 1578668901 NPPES
Other 2050712 PK
MEDICAID 00030384 PK

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