Provider Demographics
NPI:1346279015
Name:COMMUNITY HOME CARE PHARMACY INC.
Entity Type:Organization
Organization Name:COMMUNITY HOME CARE PHARMACY INC.
Other - Org Name:FAILLA'S VITAL CARE INC.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:L
Authorized Official - Last Name:FAILLA
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:601-798-4846
Mailing Address - Street 1:PO BOX 10
Mailing Address - Street 2:
Mailing Address - City:PICAYUNE
Mailing Address - State:MS
Mailing Address - Zip Code:39466
Mailing Address - Country:US
Mailing Address - Phone:601-798-4846
Mailing Address - Fax:601-798-4825
Practice Address - Street 1:110 HIGHWAY 11 N
Practice Address - Street 2:SUITE A
Practice Address - City:PICAYUNE
Practice Address - State:MS
Practice Address - Zip Code:39466-3312
Practice Address - Country:US
Practice Address - Phone:601-798-4830
Practice Address - Fax:601-798-4825
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-03
Last Update Date:2020-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS05766/02.0332B00000X, 332BC3200X, 332BP3500X, 332BX2000X, 333600000X, 3336C0003X, 3336H0001X, 3336L0003X, 3336M0002X, 3336S0011X
3336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
No332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
No333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
No3336M0002XSuppliersPharmacyMail Order Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS000015706OtherBCBS OF MS
MS01155851Medicaid
MS1262846Medicaid
MS00040327Medicaid
MS000015704OtherBCBS
MS0576611.2OtherMS BOARD OF PHARMACY