Provider Demographics
NPI:1386204717
Name:M & S PHARMACY, INC.
Entity Type:Organization
Organization Name:M & S PHARMACY, INC.
Other - Org Name:M & S PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF PHARMACY OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:BRADLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:936-462-3666
Mailing Address - Street 1:917 E AUSTIN ST
Mailing Address - Street 2:
Mailing Address - City:NACOGDOCHES
Mailing Address - State:TX
Mailing Address - Zip Code:75965-2845
Mailing Address - Country:US
Mailing Address - Phone:936-564-7373
Mailing Address - Fax:936-564-9338
Practice Address - Street 1:917 E AUSTIN ST
Practice Address - Street 2:
Practice Address - City:NACOGDOCHES
Practice Address - State:TX
Practice Address - Zip Code:75965-2845
Practice Address - Country:US
Practice Address - Phone:936-564-7373
Practice Address - Fax:936-564-9338
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-18
Last Update Date:2023-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX142098Medicaid