Provider Demographics
NPI:1831419688
Name:GLUCKSTADT SPECIAL CARE PHARMACY & COMPOUNDING
Entity type:Organization
Organization Name:GLUCKSTADT SPECIAL CARE PHARMACY & COMPOUNDING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHARMACIST
Authorized Official - Prefix:MR
Authorized Official - First Name:MITCHELL
Authorized Official - Middle Name:C
Authorized Official - Last Name:BARRETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-529-9341
Mailing Address - Street 1:1716 HWY 51 NORTH
Mailing Address - Street 2:SUITE N
Mailing Address - City:MADISON
Mailing Address - State:MS
Mailing Address - Zip Code:39110
Mailing Address - Country:US
Mailing Address - Phone:601-636-5555
Mailing Address - Fax:601-638-1564
Practice Address - Street 1:1716 HIGHWAY 51
Practice Address - Street 2:SUITE N
Practice Address - City:MADISON
Practice Address - State:MS
Practice Address - Zip Code:39110-5020
Practice Address - Country:US
Practice Address - Phone:601-636-5555
Practice Address - Fax:601-638-1564
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-03
Last Update Date:2010-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS08504333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy