Provider Demographics
NPI:1245521574
Name:FIRST PHARMACY COMPOUNDING SERVICES
Entity type:Organization
Organization Name:FIRST PHARMACY COMPOUNDING SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DENISE
Authorized Official - Middle Name:M
Authorized Official - Last Name:PRATT
Authorized Official - Suffix:
Authorized Official - Credentials:DPH
Authorized Official - Phone:662-893-6300
Mailing Address - Street 1:PO BOX 47
Mailing Address - Street 2:
Mailing Address - City:POPE
Mailing Address - State:MS
Mailing Address - Zip Code:38658-0047
Mailing Address - Country:US
Mailing Address - Phone:662-893-6300
Mailing Address - Fax:662-893-6323
Practice Address - Street 1:5185 GETWELL RD
Practice Address - Street 2:
Practice Address - City:SOUTHAVEN
Practice Address - State:MS
Practice Address - Zip Code:38671-9691
Practice Address - Country:US
Practice Address - Phone:662-893-6300
Practice Address - Fax:662-893-6323
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-20
Last Update Date:2011-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS3336C0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0004XSuppliersPharmacyCompounding Pharmacy