Provider Demographics
NPI:1760424659
Name:JIM BAIN'S COMPOUNDING PHARMACY
Entity Type:Organization
Organization Name:JIM BAIN'S COMPOUNDING PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHARAMIST
Authorized Official - Prefix:MR
Authorized Official - First Name:JIM
Authorized Official - Middle Name:
Authorized Official - Last Name:BAIN
Authorized Official - Suffix:
Authorized Official - Credentials:PRH
Authorized Official - Phone:662-844-4530
Mailing Address - Street 1:PO BOX 7241
Mailing Address - Street 2:
Mailing Address - City:TUPELO
Mailing Address - State:MS
Mailing Address - Zip Code:38802-7241
Mailing Address - Country:US
Mailing Address - Phone:662-844-4530
Mailing Address - Fax:662-844-4537
Practice Address - Street 1:367 N GLOSTER ST
Practice Address - Street 2:
Practice Address - City:TUPELO
Practice Address - State:MS
Practice Address - Zip Code:38804-3633
Practice Address - Country:US
Practice Address - Phone:662-844-4530
Practice Address - Fax:662-844-4537
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS2101-1513-3453-350183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183700000XPharmacy Service ProvidersPharmacy TechnicianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS2586139OtherNCPDP