Provider Demographics
NPI:1437513876
Name:THE TRANSPLANT PHARMACY, LLC
Entity Type:Organization
Organization Name:THE TRANSPLANT PHARMACY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:GULLEY
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:769-230-8335
Mailing Address - Street 1:630 LAKELAND EAST DR STE B
Mailing Address - Street 2:
Mailing Address - City:FLOWOOD
Mailing Address - State:MS
Mailing Address - Zip Code:39232-9565
Mailing Address - Country:US
Mailing Address - Phone:769-230-8335
Mailing Address - Fax:769-230-8337
Practice Address - Street 1:630 LAKELAND EAST DR STE B
Practice Address - Street 2:
Practice Address - City:FLOWOOD
Practice Address - State:MS
Practice Address - Zip Code:39232-9565
Practice Address - Country:US
Practice Address - Phone:769-230-8335
Practice Address - Fax:769-230-8337
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-12
Last Update Date:2022-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS3336C0003X
3336S0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS05207225Medicaid
7545410001Medicare NSC