South Street Pharmacy
LBN: South Street Pharmacy
South Street Pharmacy is an health care organization with primary practice located at 410 South St , Cleveland MS 38732-3450. The organization recently has 3 registered licenses in different health care specialties including Pharmacy Service Providers / Pharmacist, Suppliers / Community/Retail Pharmacy, Suppliers / Long Term Care Pharmacy. Suppliers / Community/Retail Pharmacy is the primary health care specialty.
South Street Pharmacy can be contacted via phone (662) 843-6700, or through Clark, Michael Stuart via phone (662) 843-6700.
Contact Information
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Pharmacy Service Providers / Pharmacist | 183500000X | 05857 | Mississippi |
| Suppliers / Community/Retail Pharmacy | 3336C0003X | ||
| Suppliers / Long Term Care Pharmacy | 3336L0003X |
Profile Details
| NPI number | 1306906482 |
|---|---|
| LBN Legal business name | South Street Pharmacy |
| DBA Doing business as | |
| Authorized official | Clark, Michael Stuart |
| Entity | Organization |
| Organization subpart 1 | No |
| Enumeration date | Dec 11th, 2006 |
| Last updated | Mar 20th, 2018 - about 6 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.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1306906482 | NPPES |
| Mississippi | MEDICAID | 04686806 | |
| Mississippi | MEDICAID | 03181784 | |
| Mississippi | Other | 2521513 | |
| Mississippi | Other | 09058522 |
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