Provider Demographics
NPI:1669961405
Name:SPECIALIZED CLINICAL PHARMACY, LLC
Entity type:Organization
Organization Name:SPECIALIZED CLINICAL PHARMACY, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST IN CHARGE
Authorized Official - Prefix:MR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:ASHBROOK
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:662-281-0000
Mailing Address - Street 1:1194 S 18TH STREET EXT
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:MS
Mailing Address - Zip Code:38655-5378
Mailing Address - Country:US
Mailing Address - Phone:662-281-0000
Mailing Address - Fax:662-281-0003
Practice Address - Street 1:1194 S 18TH STREET EXT
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:MS
Practice Address - Zip Code:38655-5378
Practice Address - Country:US
Practice Address - Phone:662-281-0000
Practice Address - Fax:662-281-0003
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-08
Last Update Date:2021-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
MS167613336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2176836OtherPK