Provider Demographics
NPI:1629114285
Name:KLEPZIG SMITH INC
Entity Type:Organization
Organization Name:KLEPZIG SMITH INC
Other - Org Name:MEDICINE SHOPPE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:MIKE
Authorized Official - Middle Name:
Authorized Official - Last Name:KLEPZIG
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:662-893-7400
Mailing Address - Street 1:9065 SANDIDGE CENTER COVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:OLIVE BRANCH
Mailing Address - State:MS
Mailing Address - Zip Code:38654
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:9065 SANDIDGE CENTER COVE
Practice Address - Street 2:SUITE A
Practice Address - City:OLIVE BRANCH
Practice Address - State:MS
Practice Address - Zip Code:38654
Practice Address - Country:US
Practice Address - Phone:662-893-7400
Practice Address - Fax:662-893-7402
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-30
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS0413301333600000X
3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00330384Medicaid
2519277OtherOTHER ID NUMBER-COMMERCIAL NUMBER
MSBT5741613OtherDEA #
MSBT5741613OtherDEA #