NPIMap

Organization Active NPI

Pharmedium Services LLC

  • Compounding Pharmacy
  • Cleveland, MS
National Provider Identifier
1013167824
Registry record updated Jun 22, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Compounding PharmacyTaxonomy code 3336C0004X
License
05336/02.0 Issued in MS
Legal business name
PHARMEDIUM SERVICES LLC
Doing business as
Pharmedium Services LLC
Practice address
913 N Davis Ave
Cleveland, MS 38732-2106
Phone
(662) 846-5969
Fax
(662) 864-2614
NPI assigned
Sep 29, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 22, 2010

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Gary Griffin
Title
RPH in Charge
Phone
(662) 846-5969

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Compounding Pharmacy 3336C0004X 05336/02.0 MS Primary

Addresses

Primary practice location

913 N Davis Ave
Cleveland, MS 38732-2106

Mailing address

913 N Davis Ave
Cleveland, MS 38732-2106
Phone (662) 846-5969

Other identifiers 1

IdentifierTypeStateIssuer
2587357OtherNCPDP PROVIDER IDENTIFICATION NUMBER

Other names 1

  • Pharmedium Services LLC Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Pharmedium Services LLC4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

Organizations that report the same tax identification number in the National Provider Directory.

Locations

913 N Davis Ave
Cleveland, MS 38732
Phone (662) 846-5969

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1222646400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1277164800000",
    "number": "1013167824",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "913 N DAVIS AVE",
            "city": "CLEVELAND",
            "state": "MS",
            "postal_code": "387322106",
            "telephone_number": "662-846-5969",
            "fax_number": "662-864-2614"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "913 N DAVIS AVE",
            "city": "CLEVELAND",
            "state": "MS",
            "postal_code": "387322106",
            "telephone_number": "662-846-5969",
            "fax_number": "662-864-2614"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PHARMEDIUM SERVICES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-09-29",
        "last_updated": "2010-06-22",
        "status": "A",
        "authorized_official_last_name": "GRIFFIN",
        "authorized_official_first_name": "GARY",
        "authorized_official_title_or_position": "RPH IN CHARGE",
        "authorized_official_telephone_number": "662-846-5969"
    },
    "taxonomies": [
        {
            "code": "3336C0004X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Compounding Pharmacy",
            "state": "MS",
            "license": "05336/02.0",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCPDP PROVIDER IDENTIFICATION NUMBER",
            "identifier": "2587357",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Pharmedium Services LLC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Cleveland, MS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 22, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.