Provider Demographics
NPI:1013016070
Name:F AND M SPECIALTY PHARMACY INC
Entity Type:Organization
Organization Name:F AND M SPECIALTY PHARMACY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE-PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:HENRY
Authorized Official - Middle Name:FOX
Authorized Official - Last Name:SKELTON
Authorized Official - Suffix:II
Authorized Official - Credentials:RPH
Authorized Official - Phone:601-939-9353
Mailing Address - Street 1:118 VILLAGE ST
Mailing Address - Street 2:SUITE D
Mailing Address - City:SLIDELL
Mailing Address - State:LA
Mailing Address - Zip Code:70458-5302
Mailing Address - Country:US
Mailing Address - Phone:985-781-6798
Mailing Address - Fax:985-781-9580
Practice Address - Street 1:118 VILLAGE ST
Practice Address - Street 2:SUITE D
Practice Address - City:SLIDELL
Practice Address - State:LA
Practice Address - Zip Code:70458-5302
Practice Address - Country:US
Practice Address - Phone:985-781-6798
Practice Address - Fax:985-781-9580
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-22
Last Update Date:2008-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA5202-IR333600000X, 3336C0003X, 3336S0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1271276Medicaid
MS00804028Medicaid
MS00804028Medicaid