Medi Mart Pharmacies of Mississippi, Inc.

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

01148/01.1 Issued in MS

Legal business name

MEDI MART PHARMACIES OF MISSISSIPPI, INC.

Doing business as

Medi Mart Pharmacy

Practice address

3737 Main St
Moss Point, MS 39563-5107

Phone

(228) 474-1011

Fax

(228) 474-1033

NPI assigned

Oct 3, 2006

Last updated

Aug 22, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mr. Clarence E. Dubose Sr., R.PH.NPI 1003038894

Title

President

Phone

(228) 474-1011

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Medi Mart Pharmacy Doing business as

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Clarence E. Dubose Sr., R.PH.

  • Pharmacist
  • Moss Point, MS
  • NPI 1003038894
  NPD (past) Authorized official

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

{
    "created_epoch": "1159833600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1043304033",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3737 MAIN ST",
            "city": "MOSS POINT",
            "state": "MS",
            "postal_code": "395635107",
            "telephone_number": "228-474-1011",
            "fax_number": "228-474-1033"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3737 MAIN ST",
            "city": "MOSS POINT",
            "state": "MS",
            "postal_code": "395635107",
            "telephone_number": "228-474-1011",
            "fax_number": "228-474-1033"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEDI MART PHARMACIES OF MISSISSIPPI, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-03",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "DUBOSE",
        "authorized_official_first_name": "CLARENCE",
        "authorized_official_middle_name": "E.",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "228-474-1011",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_name_suffix": "Sr.",
        "authorized_official_credential": "R.PH."
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "MS",
            "license": "01148/01.1",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00030113",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Medi Mart Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Jessica McDonald
• Patrick Conrad McGuire II, MD
• Reba J McMellon, M.S., LPC
• Steve McMellon, RPH
• Vicki McMillan
• Janice L Miles, DO
• Miller Pharmacy
• Misissippi Providence Healthcare Services, Inc.
• Missing Peace Enterprise
• Chrystal Mitchell, MS, LPC-S

• Community/Retail Pharmacy in Moss Point, MS
• Providers in Moss Point, MS by specialty
• Community/Retail Pharmacy in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.