South Street Pharmacy
Organization Active NPI Community/Retail Pharmacy · Cleveland, MS
NPI 1306906482 · NPPES record last updated Mar 20, 2018
Key facts
- NPI
- 1306906482
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Community/Retail Pharmacy 3336C0003X
- Legal business name
- SOUTH STREET PHARMACY
- Practice address
- 410 South St
Cleveland, MS 38732-3450 - Phone
- (662) 843-6700
- NPI assigned
- Dec 11, 2006
- Organization subpart
- No
Authorized official
- Name
- Michael Stuart Clark II
- Title
- Pharmacist Owner
- Phone
- (662) 843-6700
Practitioners 1
National Provider Directory
Locations
410 South St
Cleveland, MS 38732
Phone (662) 843-6700
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist |
183500000X | 05857 | MS | |
| Community/Retail Pharmacy | 3336C0003X | Yes | ||
| Long Term Care Pharmacy | 3336L0003X |
Addresses
Primary practice location
410 South St
Cleveland, MS 38732-3450
Mailing address
PO Box 1748
410 South Street
Cleveland, MS 38732-1748
Phone (662) 843-6700
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 04686806 | Medicaid | MS | |
| 03181784 | Medicaid | MS | |
| 2521513 | Other | MS | NABP NUMBER |
| 09058522 | Other | MS | MEDICAID DME |
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All providers in Cleveland, MS · Community/Retail Pharmacy in Mississippi
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 20, 2018. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.