Provider Demographics
NPI:1952525842
Name:MS STATE DEPT OF HEALTH
Entity Type:Organization
Organization Name:MS STATE DEPT OF HEALTH
Other - Org Name:MS STATE DEPT OF HEALTH PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIR OF PHCY
Authorized Official - Prefix:
Authorized Official - First Name:MARGARET
Authorized Official - Middle Name:
Authorized Official - Last Name:PEARSON
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD, MS
Authorized Official - Phone:601-713-3457
Mailing Address - Street 1:3156 LAWSON ST
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39213-5754
Mailing Address - Country:US
Mailing Address - Phone:601-713-3457
Mailing Address - Fax:601-364-2670
Practice Address - Street 1:3156 LAWSON ST
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39213-5754
Practice Address - Country:US
Practice Address - Phone:601-713-3457
Practice Address - Fax:601-364-2670
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-12
Last Update Date:2018-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336L0003X, 3336M0002X, 3336S0011X
MS01085/5.13336C0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0002XSuppliersPharmacyClinic Pharmacy
No333600000XSuppliersPharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No3336M0002XSuppliersPharmacyMail Order Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2047531OtherPK
MS00030135Medicaid