NPIMap

Organization Active NPI

Funderburks Pharmacy Inc

  • Pharmacy
  • Hernando, MS
National Provider Identifier
1295703536
Registry record updated Mar 24, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
PharmacyTaxonomy code 333600000X
License
00908/01.1 Issued in MS
Legal business name
FUNDERBURKS PHARMACY INC
Practice address
134 W Commerce St
Hernando, MS 38632-2240
Phone
(662) 429-5337
NPI assigned
Mar 11, 2006
Last updated
Mar 24, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 24, 2023

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

Authorized official

Name
Mrs. Cheryl M Sudduth, R.PH.NPI 1811066616
Title
President
Phone
(662) 429-5337

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacy 333600000X 00908/01.1 MS Primary

Addresses

Primary practice location

134 W Commerce St
Hernando, MS 38632-2240

Mailing address

134 W Commerce St
Hernando, MS 38632-2240
Phone (662) 429-5337

Other identifiers 2

IdentifierTypeStateIssuer
00440498MedicaidMS
0030125MedicaidMS

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MS

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20100930025115 MS DME Supplier - Pharmacy 5193786861 Practice locations: Hernando, MS

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory
Tax ID family
Funderburks Pharmacy3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

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

Ownership & related parties

Subparts reporting this organization as parent 1

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

Practitioners & affiliated clinicians

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.

NPI Registry JSON

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

{
    "created_epoch": "1142035200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1679616000000",
    "number": "1295703536",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "134 W COMMERCE ST",
            "city": "HERNANDO",
            "state": "MS",
            "postal_code": "386322240",
            "telephone_number": "662-429-5337"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "134 W COMMERCE ST",
            "city": "HERNANDO",
            "state": "MS",
            "postal_code": "386322240",
            "telephone_number": "662-429-5337"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FUNDERBURKS PHARMACY INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-03-11",
        "last_updated": "2023-03-24",
        "certification_date": "2023-03-24",
        "status": "A",
        "authorized_official_last_name": "SUDDUTH",
        "authorized_official_first_name": "CHERYL",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "662-429-5337",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "R.PH."
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "MS",
            "license": "00908/01.1",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00440498",
            "state": "MS"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0030125",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Hernando, MS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 24, 2023; 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.