Midsouth Medical Specialties LLC

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

Legal business name

MIDSOUTH MEDICAL SPECIALTIES LLC

Doing business as

Super Drug

Practice address

1433 Goodman Rd W
Horn Lake, MS 38637

Phone

(662) 280-7455

Fax

(662) 280-7457

NPI assigned

Oct 14, 2008

Last updated

Jan 8, 2024By 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

Super Drugs, RPH

Title

Owner

Phone

(662) 280-7455

Specialties & licenses 3

Addresses

Other identifiers 3

Other names 1

• Super Drug Doing business as

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

{
    "created_epoch": "1223942400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1704672000000",
    "number": "1487806121",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 563",
            "city": "HERNANDO",
            "state": "MS",
            "postal_code": "386320563",
            "telephone_number": "662-280-7455",
            "fax_number": "662-280-7457"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1433 GOODMAN RD W",
            "city": "HORN LAKE",
            "state": "MS",
            "postal_code": "38637",
            "telephone_number": "662-280-7455",
            "fax_number": "662-280-7457"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MIDSOUTH MEDICAL SPECIALTIES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-10-14",
        "last_updated": "2024-01-08",
        "certification_date": "2021-11-08",
        "status": "A",
        "authorized_official_last_name": "DRUGS",
        "authorized_official_first_name": "SUPER",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "662-280-7455",
        "authorized_official_credential": "RPH"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "3336S0011X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Specialty Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0004X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Compounding Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02434788",
            "state": "MS"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2117404",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1534074",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Super Drug",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• McKenzie Alexandra McClanahan, DPT
• Memphis Emergency Specialists PC (Southern Family Medical Clinic)
• Mid South Chiropractic of Horn Lake PLLC
• Ragan Danielle Middleton, SLPMI
• William E. Middleton Jr., D.D.S.
• Midsouth Medical Specialties LLC (Super Drugs)
• R. Alan Minks, D.C.
• Kelsey Barnett Mize
• Yolanda Murry, FNP-C
• Newsom Healthcare of Desoto County, LLC

• Community/Retail Pharmacy in Horn Lake, MS
• Providers in Horn Lake, 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 Jan 8, 2024; 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.