Provider Demographics
NPI:1902359342
Name:ASM INC
Entity Type:Organization
Organization Name:ASM INC
Other - Org Name:MIKE'S PHARMACY, A MEMEBER OF THE MEDICINE SHOPPE FAMILY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST IN CHARGE
Authorized Official - Prefix:
Authorized Official - First Name:MIKE
Authorized Official - Middle Name:
Authorized Official - Last Name:KLEPZIG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:662-892-8448
Mailing Address - Street 1:9065 SANDIDGE CENTER CV
Mailing Address - Street 2:SUITE A
Mailing Address - City:OLIVE BRANCH
Mailing Address - State:MS
Mailing Address - Zip Code:38654-3574
Mailing Address - Country:US
Mailing Address - Phone:662-892-8448
Mailing Address - Fax:662-892-8189
Practice Address - Street 1:9065 SANDIDGE CENTER CV
Practice Address - Street 2:SUITE A
Practice Address - City:OLIVE BRANCH
Practice Address - State:MS
Practice Address - Zip Code:38654-3574
Practice Address - Country:US
Practice Address - Phone:662-892-8448
Practice Address - Fax:662-892-8189
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-02
Last Update Date:2016-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 333600000X, 3336C0004X
MS14901/1.13336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS0040940Medicaid
2162413OtherPK