Provider Demographics
NPI:1598806143
Name:MEDICAL ARTS PHARMACY OF COLUMBUS INC
Entity Type:Organization
Organization Name:MEDICAL ARTS PHARMACY OF COLUMBUS INC
Other - Org Name:MEDICAL ARTS PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:WALDEN
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:662-328-8660
Mailing Address - Street 1:504 MILITARY RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:MS
Mailing Address - Zip Code:39701-4681
Mailing Address - Country:US
Mailing Address - Phone:662-328-8660
Mailing Address - Fax:662-328-1213
Practice Address - Street 1:504 MILITARY RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:MS
Practice Address - Zip Code:39701-4681
Practice Address - Country:US
Practice Address - Phone:662-328-8660
Practice Address - Fax:662-328-1213
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS017903336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00330641Medicaid
MS00440865Medicaid
MS00330641Medicaid