Provider Demographics
NPI:1881064772
Name:APPLE PHARMACEUTICALS & HEALTHCARE SERVICES, LLC
Entity type:Organization
Organization Name:APPLE PHARMACEUTICALS & HEALTHCARE SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:DE'SHAWN
Authorized Official - Middle Name:N
Authorized Official - Last Name:GRAVES
Authorized Official - Suffix:
Authorized Official - Credentials:CPHT
Authorized Official - Phone:850-630-6072
Mailing Address - Street 1:115 RILEY DR
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39209-2595
Mailing Address - Country:US
Mailing Address - Phone:601-923-4200
Mailing Address - Fax:601-923-2771
Practice Address - Street 1:115 RILEY DR
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39209-2595
Practice Address - Country:US
Practice Address - Phone:601-923-4200
Practice Address - Fax:601-923-2771
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-05
Last Update Date:2015-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS291U00000X, 332100000X, 3336C0003X, 3336C0004X, 3336M0002X, 183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183700000XPharmacy Service ProvidersPharmacy TechnicianGroup - Multi-Specialty
No291U00000XLaboratoriesClinical Medical LaboratoryGroup - Multi-Specialty
No332100000XSuppliersDepartment of Veterans Affairs (VA) Pharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336M0002XSuppliersPharmacyMail Order Pharmacy