Provider Demographics
NPI:1134226210
Name:AVAILABLE PHARMACEUTICAL SERVICES
Entity type:Organization
Organization Name:AVAILABLE PHARMACEUTICAL SERVICES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JIM
Authorized Official - Middle Name:R
Authorized Official - Last Name:KELLY
Authorized Official - Suffix:
Authorized Official - Credentials:R PH
Authorized Official - Phone:601-782-9943
Mailing Address - Street 1:PO BOX 296
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:MS
Mailing Address - Zip Code:39153-0296
Mailing Address - Country:US
Mailing Address - Phone:601-782-9943
Mailing Address - Fax:601-782-9968
Practice Address - Street 1:138 OIL FIELD RD # 77
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:MS
Practice Address - Zip Code:39153-6428
Practice Address - Country:US
Practice Address - Phone:601-782-9943
Practice Address - Fax:601-782-9968
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2007-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS05184/11.1332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00440265Medicaid
MS0995910001Medicare NSC