Provider Demographics
NPI:1043510381
Name:HEMOPHILIA SPECIALTY GROUP, LLC
Entity Type:Organization
Organization Name:HEMOPHILIA SPECIALTY GROUP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:RONNIE
Authorized Official - Middle Name:
Authorized Official - Last Name:RESPESS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:662-809-2727
Mailing Address - Street 1:1500 GATEWAY ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:GRENADA
Mailing Address - State:MS
Mailing Address - Zip Code:38901-2846
Mailing Address - Country:US
Mailing Address - Phone:662-809-2727
Mailing Address - Fax:
Practice Address - Street 1:1500 GATEWAY ST
Practice Address - Street 2:SUITE B
Practice Address - City:GRENADA
Practice Address - State:MS
Practice Address - Zip Code:38901-2846
Practice Address - Country:US
Practice Address - Phone:662-809-2727
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RHKM, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-11-02
Last Update Date:2010-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS08701/2.03336S0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336S0011XSuppliersPharmacySpecialty Pharmacy