Provider Demographics
NPI:1033102884
Name:N.M.R.C. PHARMACY
Entity Type:Organization
Organization Name:N.M.R.C. PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:
Authorized Official - Last Name:IVY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:662-513-7690
Mailing Address - Street 1:967 REGIONAL CENTER DR
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:MS
Mailing Address - Zip Code:38655-3551
Mailing Address - Country:US
Mailing Address - Phone:662-234-1476
Mailing Address - Fax:662-234-1699
Practice Address - Street 1:967 REGIONAL CENTER DR
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:MS
Practice Address - Zip Code:38655
Practice Address - Country:US
Practice Address - Phone:662-234-1476
Practice Address - Fax:662-234-1699
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-26
Last Update Date:2018-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS00959/03.1333600000X
MS3336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS25-19188OtherNABP
MS00030418Medicaid