Provider Demographics
NPI:1114075595
Name:HOME OXYGEN & MEDICAL EQUIPMENT INC
Entity Type:Organization
Organization Name:HOME OXYGEN & MEDICAL EQUIPMENT INC
Other - Org Name:PARKWAY PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:WESLEY
Authorized Official - Middle Name:A
Authorized Official - Last Name:MILEY
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:601-924-8935
Mailing Address - Street 1:PO BOX 1395
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:MS
Mailing Address - Zip Code:39060-1395
Mailing Address - Country:US
Mailing Address - Phone:601-924-8935
Mailing Address - Fax:601-924-9127
Practice Address - Street 1:134 E NORTHSIDE DR
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:MS
Practice Address - Zip Code:39056-3659
Practice Address - Country:US
Practice Address - Phone:601-924-8935
Practice Address - Fax:601-924-9127
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-08
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS02413 01.13336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS2517627OtherNCPDP#
MS00330062Medicaid
MS00330062Medicaid
MS00330062Medicaid
MS2517627OtherNCPDP#