Provider Demographics
NPI:1225661465
Name:THOMAS STREET COMPOUNDING PHARMACY
Entity Type:Organization
Organization Name:THOMAS STREET COMPOUNDING PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:MARC
Authorized Official - Last Name:GUNNELLS
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:662-844-0400
Mailing Address - Street 1:86 S THOMAS ST
Mailing Address - Street 2:
Mailing Address - City:TUPELO
Mailing Address - State:MS
Mailing Address - Zip Code:38801-4355
Mailing Address - Country:US
Mailing Address - Phone:662-844-0444
Mailing Address - Fax:
Practice Address - Street 1:86 S THOMAS ST
Practice Address - Street 2:
Practice Address - City:TUPELO
Practice Address - State:MS
Practice Address - Zip Code:38801-4355
Practice Address - Country:US
Practice Address - Phone:662-844-0444
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-17
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS17627OtherPHARMACY
MS17627OtherPHARMACY