Provider Demographics
NPI:1457973067
Name:THOMAS STREET COMPOUNDING PHARMACY
Entity Type:Organization
Organization Name:THOMAS STREET COMPOUNDING PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:NATALYA
Authorized Official - Middle Name:
Authorized Official - Last Name:WIGGINTON
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:662-844-8552
Mailing Address - Street 1:115 N THOMAS ST STE G
Mailing Address - Street 2:
Mailing Address - City:TUPELO
Mailing Address - State:MS
Mailing Address - Zip Code:38801-3082
Mailing Address - Country:US
Mailing Address - Phone:662-844-8552
Mailing Address - Fax:662-844-8504
Practice Address - Street 1:115 N THOMAS ST STE G
Practice Address - Street 2:
Practice Address - City:TUPELO
Practice Address - State:MS
Practice Address - Zip Code:38801-3082
Practice Address - Country:US
Practice Address - Phone:662-844-8552
Practice Address - Fax:662-844-8504
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-18
Last Update Date:2020-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy