Sports Medicine Pharmacy
LBN: Sports Medicine Pharmacy Llc
Sports Medicine Pharmacy is an health care organization with primary practice located at 1325 E Fortification St , Jackson MS 39202-2442. The organization recently has 3 registered licenses in different health care specialties including Suppliers / Pharmacy, Suppliers / Clinic Pharmacy, Suppliers / Community/Retail Pharmacy. Suppliers / Pharmacy is the primary health care specialty.
Sports Medicine Pharmacy Llc can be contacted via phone (601) 354-4488, or through Calvert, Randy via phone (601) 672-1534.
Contact Information
Primary practice address
1325 E Fortification St
Jackson MS 39202-2442
Phone: (601) 354-4488
Fax: (769) 777-6390
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Suppliers / Pharmacy | 333600000X | 14908 | Mississippi |
| Suppliers / Clinic Pharmacy | 3336C0002X | ||
| Suppliers / Community/Retail Pharmacy | 3336C0003X |
Profile Details
| NPI number | 1912452921 |
|---|---|
| LBN Legal business name | Sports Medicine Pharmacy Llc |
| DBA Doing business as | Sports Medicine Pharmacy |
| Authorized official | Calvert, Randy |
| Entity | Organization |
| Organization subpart 1 | No |
| Enumeration date | Aug 19th, 2016 |
| Last updated | Jan 13th, 2017 - about 7 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 | 1912452921 | NPPES |
| Mississippi | MEDICAID | 06600515 | |
| Mississippi | Other | 2162491 |
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