Provider Demographics
NPI:1881870228
Name:LOWER CROSSING PHARMACY LLC
Entity type:Organization
Organization Name:LOWER CROSSING PHARMACY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PIC
Authorized Official - Prefix:
Authorized Official - First Name:LINDY
Authorized Official - Middle Name:
Authorized Official - Last Name:MCMANUS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:662-844-8880
Mailing Address - Street 1:PO BOX 407
Mailing Address - Street 2:
Mailing Address - City:SHERMAN
Mailing Address - State:MS
Mailing Address - Zip Code:38869-0407
Mailing Address - Country:US
Mailing Address - Phone:662-844-8880
Mailing Address - Fax:662-844-8885
Practice Address - Street 1:670 HIGHWAY 178 W
Practice Address - Street 2:STE 1
Practice Address - City:SHERMAN
Practice Address - State:MS
Practice Address - Zip Code:38869-7000
Practice Address - Country:US
Practice Address - Phone:662-844-8880
Practice Address - Fax:662-844-8885
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-16
Last Update Date:2020-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
MSF076033336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS09170701Medicaid
2047530OtherPK