Provider Demographics
NPI:1811932171
Name:PHARMACY MANAGEMENT GROUP
Entity type:Organization
Organization Name:PHARMACY MANAGEMENT GROUP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE ASSISTANT
Authorized Official - Prefix:
Authorized Official - First Name:MISTY
Authorized Official - Middle Name:
Authorized Official - Last Name:OSWALT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:662-327-4025
Mailing Address - Street 1:203 S CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:OKOLONA
Mailing Address - State:MS
Mailing Address - Zip Code:38860-1608
Mailing Address - Country:US
Mailing Address - Phone:662-447-5400
Mailing Address - Fax:
Practice Address - Street 1:203 S CHURCH ST
Practice Address - Street 2:
Practice Address - City:OKOLONA
Practice Address - State:MS
Practice Address - Zip Code:38860-1608
Practice Address - Country:US
Practice Address - Phone:662-447-5400
Practice Address - Fax:662-447-3043
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-19
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS074743336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS2520078OtherNCPCP
2520078OtherOTHER ID NUMBER-COMMERCIAL NUMBER
2520078OtherOTHER ID NUMBER-COMMERCIAL NUMBER