Provider Demographics
NPI:1336520188
Name:REDIMEDS PHARMACY, LLC
Entity Type:Organization
Organization Name:REDIMEDS PHARMACY, LLC
Other - Org Name:REDIMEDS PHARMACY, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PIC
Authorized Official - Prefix:
Authorized Official - First Name:DEBRALEE
Authorized Official - Middle Name:
Authorized Official - Last Name:CARROLL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:662-350-3119
Mailing Address - Street 1:3466 MCCULLOUGH BLVD STE D-2
Mailing Address - Street 2:
Mailing Address - City:BELDEN
Mailing Address - State:MS
Mailing Address - Zip Code:38826-9468
Mailing Address - Country:US
Mailing Address - Phone:662-350-3119
Mailing Address - Fax:662-260-4074
Practice Address - Street 1:3466 MCCULLOUGH BLVD STE D-2
Practice Address - Street 2:
Practice Address - City:BELDEN
Practice Address - State:MS
Practice Address - Zip Code:38826-9468
Practice Address - Country:US
Practice Address - Phone:662-350-3119
Practice Address - Fax:662-260-4047
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-17
Last Update Date:2023-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS14365/2.33336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2152587OtherPK