Provider Demographics
NPI:1225378946
Name:MEDISEND SPECIALTY PHARMACY INC
Entity Type:Organization
Organization Name:MEDISEND SPECIALTY PHARMACY INC
Other - Org Name:MEDISEND SPECIALTY PHARMACY INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:
Authorized Official - Last Name:KING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:662-293-0220
Mailing Address - Street 1:127 PRATT DR
Mailing Address - Street 2:
Mailing Address - City:CORINTH
Mailing Address - State:MS
Mailing Address - Zip Code:38834-6026
Mailing Address - Country:US
Mailing Address - Phone:662-287-6405
Mailing Address - Fax:662-286-5898
Practice Address - Street 1:127 PRATT DR
Practice Address - Street 2:
Practice Address - City:CORINTH
Practice Address - State:MS
Practice Address - Zip Code:38834-6026
Practice Address - Country:US
Practice Address - Phone:662-287-6405
Practice Address - Fax:662-286-5898
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-15
Last Update Date:2013-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS121053336C0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2138531OtherPK