Provider Demographics
NPI:1881087427
Name:INFUSION CENTER PHARMACY
Entity type:Organization
Organization Name:INFUSION CENTER PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF PHARMACY
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:TODARO
Authorized Official - Suffix:JR
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:601-984-2055
Mailing Address - Street 1:2500 N STATE ST
Mailing Address - Street 2:PHARMACY ADMINISTRATION
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39216-4500
Mailing Address - Country:US
Mailing Address - Phone:601-984-2055
Mailing Address - Fax:601-984-2063
Practice Address - Street 1:5903 RIDGEWOOD RD
Practice Address - Street 2:SUITE 110
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39211-3700
Practice Address - Country:US
Practice Address - Phone:601-984-2055
Practice Address - Fax:601-984-2063
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:UNIV OF MS MEDICAL CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-03-06
Last Update Date:2015-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS14251/2.1261QI0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QI0500XAmbulatory Health Care FacilitiesClinic/CenterInfusion Therapy