Provider Demographics
NPI:1043239031
Name:IUKA PHARMACY SERVICES LLC
Entity Type:Organization
Organization Name:IUKA PHARMACY SERVICES LLC
Other - Org Name:IUKA DISCOUNT DRUGS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:GRIFFIN
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:662-423-9039
Mailing Address - Street 1:1411 W QUITMAN ST
Mailing Address - Street 2:
Mailing Address - City:IUKA
Mailing Address - State:MS
Mailing Address - Zip Code:38852-1130
Mailing Address - Country:US
Mailing Address - Phone:662-423-9039
Mailing Address - Fax:662-423-9318
Practice Address - Street 1:1411 W QUITMAN ST
Practice Address - Street 2:
Practice Address - City:IUKA
Practice Address - State:MS
Practice Address - Zip Code:38852-1130
Practice Address - Country:US
Practice Address - Phone:662-423-9039
Practice Address - Fax:662-423-9318
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-19
Last Update Date:2021-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS00827011332B00000X, 333600000X
3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS04158389OtherDME MEDICAID
MS00092754Medicaid
MS00092754Medicaid