Provider Demographics
NPI:1659448934
Name:SPECIALTY SERVICES, INC.
Entity Type:Organization
Organization Name:SPECIALTY SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:J
Authorized Official - Last Name:WEILAND
Authorized Official - Suffix:
Authorized Official - Credentials:PD
Authorized Official - Phone:662-358-4500
Mailing Address - Street 1:1627 HIGHWAY 61 JONESTOWN RD
Mailing Address - Street 2:
Mailing Address - City:COAHOMA
Mailing Address - State:MS
Mailing Address - Zip Code:38617-9790
Mailing Address - Country:US
Mailing Address - Phone:662-358-4500
Mailing Address - Fax:662-358-4507
Practice Address - Street 1:1627 HIGHWAY 61 JONESTOWN RD
Practice Address - Street 2:
Practice Address - City:COAHOMA
Practice Address - State:MS
Practice Address - Zip Code:38617-9790
Practice Address - Country:US
Practice Address - Phone:662-358-4500
Practice Address - Fax:662-358-4507
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-29
Last Update Date:2010-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS04428/02.0332B00000X, 332BP3500X
AROS01422333600000X
MS04428 02.03336C0004X, 3336H0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS0330666Medicaid
AR138725733Medicaid
AR142601407Medicaid
MS0440634Medicaid
AR138724716Medicaid
MS0330666Medicaid