Ole Town Family Pharmacy LLC

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

Legal business name

OLE TOWN FAMILY PHARMACY LLC

Practice address

810 Lindley Road
Marion, MS 39342

Phone

(601) 527-4579

NPI assigned

Jun 27, 2024

Organization subpart

No

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

Authorized official

Name

Richard Andrew Moffett

Title

Owner

Phone

(601) 527-4579

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MS

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Kevin Alan Broussard, RPH ANP

  • Pharmacist
  • Meridian, MS
  • NPI 1720478340
  NPD

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

{
    "created_epoch": "1719446400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1719446400000",
    "number": "1245075688",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4733 11TH PL",
            "city": "MERIDIAN",
            "state": "MS",
            "postal_code": "393052769"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "810 LINDLEY ROAD",
            "city": "MARION",
            "state": "MS",
            "postal_code": "39342",
            "telephone_number": "601-527-4579"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OLE TOWN FAMILY PHARMACY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-06-27",
        "last_updated": "2024-06-27",
        "certification_date": "2024-06-19",
        "status": "A",
        "authorized_official_last_name": "MOFFETT",
        "authorized_official_first_name": "RICHARD",
        "authorized_official_middle_name": "ANDREW",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "601-527-4579"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jennifer P Lafferty, FNP
• Marion Discount Drugs
• Marion Health and Rehab, LLC
• Elizabeth McKenzie
• Tanika Renae Mitchell, DOCTOR OF EDUCATION
• Tiara Person
• Premier Integrated Health Services, PLLC
• Jessica Reynolds
• Daphne Richmond
• Tarrah Rose

• Community/Retail Pharmacy in Marion, MS
• Providers in Marion, 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 Jun 27, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.