Provider Demographics
NPI:1407348832
Name:FIRST PHARMACY SERVICES
Entity Type:Organization
Organization Name:FIRST PHARMACY SERVICES
Other - Org Name:FIRST PHARMACY SERVICES OF SARDIS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DENISE
Authorized Official - Middle Name:
Authorized Official - Last Name:PRATT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:662-349-6385
Mailing Address - Street 1:PO BOX 47
Mailing Address - Street 2:
Mailing Address - City:POPE
Mailing Address - State:MS
Mailing Address - Zip Code:38658-0047
Mailing Address - Country:US
Mailing Address - Phone:662-932-2092
Mailing Address - Fax:662-932-2099
Practice Address - Street 1:400 E LEE ST
Practice Address - Street 2:
Practice Address - City:SARDIS
Practice Address - State:MS
Practice Address - Zip Code:38666-1236
Practice Address - Country:US
Practice Address - Phone:662-349-6385
Practice Address - Fax:662-932-2099
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-01
Last Update Date:2018-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS17063/1.1333600000X
3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2177010OtherPK