Provider Demographics
NPI:1598750135
Name:MISSISSIPPI STATE HOSPITAL
Entity Type:Organization
Organization Name:MISSISSIPPI STATE HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACY DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:VICKI
Authorized Official - Middle Name:S
Authorized Official - Last Name:VEAZEY
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:601-351-8026
Mailing Address - Street 1:PO BOX 157A
Mailing Address - Street 2:BUILDING 50 PHARMACY
Mailing Address - City:WHITFIELD
Mailing Address - State:MS
Mailing Address - Zip Code:39193-0157
Mailing Address - Country:US
Mailing Address - Phone:601-351-8026
Mailing Address - Fax:601-351-8255
Practice Address - Street 1:3550 HIGHWAY 468 W
Practice Address - Street 2:
Practice Address - City:WHITFIELD
Practice Address - State:MS
Practice Address - Zip Code:39193
Practice Address - Country:US
Practice Address - Phone:601-351-8000
Practice Address - Fax:601-351-8255
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-20
Last Update Date:2018-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS01000/03.1283Q00000X
MS01000313M00000X, 3336I0012X
3336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336I0012XSuppliersPharmacyInstitutional Pharmacy
No283Q00000XHospitalsPsychiatric Hospital
No313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00094048Medicaid