Provider Demographics
NPI:1568132058
Name:TOTAL CARE SPECIALTY PHARMACY, LLC
Entity Type:Organization
Organization Name:TOTAL CARE SPECIALTY PHARMACY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:DE'SHAWN
Authorized Official - Middle Name:NICHELLE
Authorized Official - Last Name:GRAVES
Authorized Official - Suffix:
Authorized Official - Credentials:CPHT
Authorized Official - Phone:601-618-0002
Mailing Address - Street 1:PO BOX 820474
Mailing Address - Street 2:
Mailing Address - City:VICKSBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39182-0474
Mailing Address - Country:US
Mailing Address - Phone:601-618-0002
Mailing Address - Fax:601-501-7831
Practice Address - Street 1:4079 PEMBERTON SQUARE BLVD
Practice Address - Street 2:
Practice Address - City:VICKSBURG
Practice Address - State:MS
Practice Address - Zip Code:39180-5580
Practice Address - Country:US
Practice Address - Phone:601-618-0002
Practice Address - Fax:601-501-7831
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-15
Last Update Date:2021-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183700000XPharmacy Service ProvidersPharmacy TechnicianGroup - Single Specialty