Provider Demographics
NPI:1770127250
Name:MP SOUTHPARK PHARMACY LLC
Entity type:Organization
Organization Name:MP SOUTHPARK PHARMACY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:FINANCE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:D
Authorized Official - Last Name:WHITE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:325-655-3146
Mailing Address - Street 1:1804 HALL AVE
Mailing Address - Street 2:
Mailing Address - City:LITTLEFIELD
Mailing Address - State:TX
Mailing Address - Zip Code:79339-5439
Mailing Address - Country:US
Mailing Address - Phone:325-655-2821
Mailing Address - Fax:
Practice Address - Street 1:104 E SAN SABA ST
Practice Address - Street 2:
Practice Address - City:MENARD
Practice Address - State:TX
Practice Address - Zip Code:76859-2709
Practice Address - Country:US
Practice Address - Phone:325-396-2480
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PAY AND SAVE INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-10-29
Last Update Date:2025-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy