Provider Demographics
NPI:1942345574
Name:PHARMACY MANAGEMENT GROUP LLC
Entity Type:Organization
Organization Name:PHARMACY MANAGEMENT GROUP LLC
Other - Org Name:TOTAL CARE SPECIALTY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHRM OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:662-327-4025
Mailing Address - Street 1:425 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:MS
Mailing Address - Zip Code:39701-4533
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:425 MAIN ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:MS
Practice Address - Zip Code:39701-4533
Practice Address - Country:US
Practice Address - Phone:662-328-1766
Practice Address - Fax:662-328-9273
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-21
Last Update Date:2008-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS003633336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2500266OtherOTHER ID NUMBER
MS00030031Medicaid