Provider Demographics
NPI:1013410737
Name:PHARMACY PLUS, INC.
Entity Type:Organization
Organization Name:PHARMACY PLUS, INC.
Other - Org Name:VITAL CARE COMPOUNDER
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:JAMES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-261-0503
Mailing Address - Street 1:115 S 40TH AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39402-6600
Mailing Address - Country:US
Mailing Address - Phone:601-261-0503
Mailing Address - Fax:601-261-0127
Practice Address - Street 1:115 S 40TH AVE
Practice Address - Street 2:SUITE A
Practice Address - City:HATTIESBURG
Practice Address - State:MS
Practice Address - Zip Code:39402-6600
Practice Address - Country:US
Practice Address - Phone:601-261-0503
Practice Address - Fax:601-261-0127
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-09
Last Update Date:2018-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0003X
MS16882-1.13336C0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0004XSuppliersPharmacyCompounding Pharmacy
No333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2176612OtherPK
MSPENDINGMedicaid