Brick City Drugs, LLC
Organization Active NPI Community/Retail Pharmacy · Madison, MS
NPI 1467960484 · NPPES record last updated Feb 18, 2019
Key facts
- NPI
- 1467960484
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Community/Retail Pharmacy 3336C0003X
- License
- 16750/1.1 (MS)
- Legal business name
- BRICK CITY DRUGS, LLC
- Practice address
- 159 Fountains Blvd
Madison, MS 39110 - Phone
- (601) 859-8200
- Fax
- (601) 859-8201
- NPI assigned
- Jan 11, 2018
- Organization subpart
- No
Authorized official
- Name
- John Hegi
- Title
- Owner
- Phone
- (769) 231-1400
Practitioners 3
-
Kelly Antici, PHARMD
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 25D2193847 | Brick City Drugs | Certificate of waiver | Sep 24, 2026 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MS
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20181205001204 | MS | Part B Supplier - Pharmacy | 9234473257 | Practice locations: Madison, MS |
National Provider Directory
Locations
159 Fountains Blvd
Ste A
Madison, MS 39110
Phone (769) 231-1400
159 Fountains Blvd
Madison, MS 39110
Phone (601) 506-0604
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Durable Medical Equipment & Medical Supplies | 332B00000X | |||
| Pharmacy | 333600000X | |||
| Community/Retail Pharmacy | 3336C0003X | 16750/1.1 | MS | Yes |
Addresses
Primary practice location
159 Fountains Blvd
Madison, MS 39110
Mailing address
159 Fountains Blvd, Ste a
Madison, MS 39110-0000
Phone (769) 231-1400
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2175223 | Other | PK |
Other names
- Brick City Drugs
Other providers in Madison, MS
- Jonathan B Breaux
- Brenda B. Donald, LLC
- Mary Kamryn Brewer
- Sarah Joy Brewer
- Brick City Compounding LLC
- Bridges Clinic LLC
- James Kevin Bridges
- Julia Bristow
- Maxie Britton
- Anne Darrington Brooks
All providers in Madison, 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 Feb 18, 2019. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.