Provider Demographics
NPI:1659357978
Name:MISSISSIPPI STATE UNIVERSITY
Entity Type:Organization
Organization Name:MISSISSIPPI STATE UNIVERSITY
Other - Org Name:LONGEST STUDENT HEALTH CENTER PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT FOR STUDENT AFFAIRS
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:L
Authorized Official - Last Name:KIBLER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:662-325-3045
Mailing Address - Street 1:PO BOX 6338
Mailing Address - Street 2:
Mailing Address - City:MISSISSIPPI STATE
Mailing Address - State:MS
Mailing Address - Zip Code:39762
Mailing Address - Country:US
Mailing Address - Phone:662-325-2431
Mailing Address - Fax:662-325-8888
Practice Address - Street 1:2 HARDY ROAD
Practice Address - Street 2:
Practice Address - City:MISSISSIPPI STATE
Practice Address - State:MS
Practice Address - Zip Code:39762
Practice Address - Country:US
Practice Address - Phone:662-325-2431
Practice Address - Fax:662-325-8888
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty