Provider Demographics
NPI:1275647232
Name:MCNAMED PHARMACY LLC
Entity Type:Organization
Organization Name:MCNAMED PHARMACY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:MCNAMARA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-933-0550
Mailing Address - Street 1:4290 LAKELAND DR
Mailing Address - Street 2:STE D
Mailing Address - City:FLOWOOD
Mailing Address - State:MS
Mailing Address - Zip Code:39232-9571
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4290 LAKELAND DR
Practice Address - Street 2:STE D
Practice Address - City:FLOWOOD
Practice Address - State:MS
Practice Address - Zip Code:39232-9571
Practice Address - Country:US
Practice Address - Phone:601-933-0565
Practice Address - Fax:601-932-6215
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS05677025333600000X
3336S0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered333600000XSuppliersPharmacy
Not Answered3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS02185020Medicaid
2586115OtherOTHER ID NUMBER-COMMERCIAL NUMBER
MS02185020Medicaid