Provider Demographics
NPI:1497818934
Name:PIONEER FAMILY PHARMACY
Entity Type:Organization
Organization Name:PIONEER FAMILY PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACY MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:RAMSEY
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:662-343-5405
Mailing Address - Street 1:40128 HAMILTON RD
Mailing Address - Street 2:
Mailing Address - City:HAMILTON
Mailing Address - State:MS
Mailing Address - Zip Code:39746-9686
Mailing Address - Country:US
Mailing Address - Phone:662-343-5405
Mailing Address - Fax:662-343-5538
Practice Address - Street 1:40128 HAMILTON RD
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:MS
Practice Address - Zip Code:39746-9686
Practice Address - Country:US
Practice Address - Phone:662-343-5405
Practice Address - Fax:662-343-5538
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS03276573Medicaid
MS03276573Medicaid