Complete Diabetes Pharmacy Care Inc

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

13340 Issued in MS

Legal business name

COMPLETE DIABETES PHARMACY CARE INC

Doing business as

Complete Diabetes Pharmacy

Practice address

7165 Swinnea Rd
BLDG B-2
Southaven, MS 38671-6360

Phone

(662) 280-5533

Fax

(800) 208-0863

NPI assigned

Apr 15, 2014

Last updated

Nov 11, 2022By 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

Craig Brosseau

Title

Secretary

Phone

(952) 646-3255

Specialties & licenses 2

Addresses

Other identifiers 1

Other names 1

• Complete Diabetes Pharmacy Doing business as

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

{
    "created_epoch": "1397520000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1668124800000",
    "number": "1619396892",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7165 SWINNEA RD",
            "address_2": "BUILDING B-2",
            "city": "SOUTHAVEN",
            "state": "MS",
            "postal_code": "386716360",
            "telephone_number": "662-280-5533",
            "fax_number": "800-208-0863"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7165 SWINNEA RD",
            "address_2": "BLDG B-2",
            "city": "SOUTHAVEN",
            "state": "MS",
            "postal_code": "386716360",
            "telephone_number": "662-280-5533",
            "fax_number": "800-208-0863"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COMPLETE DIABETES PHARMACY CARE INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-04-15",
        "last_updated": "2022-11-11",
        "certification_date": "2022-11-11",
        "status": "A",
        "authorized_official_last_name": "BROSSEAU",
        "authorized_official_first_name": "CRAIG",
        "authorized_official_title_or_position": "SECRETARY",
        "authorized_official_telephone_number": "952-646-3255"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "MS",
            "license": "13340",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2145616",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Complete Diabetes Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Complete Diabetes Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Lauren Robilio Collins, FNP
• Kylle Colquhoun, DPT
• George Paul Comeaux, LCSW
• Compass Laboratory Services of Mississippi LLC
• Compassionate Nurses Healthcare
• Complete Diagnostic Laboratories, LLC
• Wyatt Compton
• Jerri J Conlee, R.PH.
• Katelyn Lee Conner, PMHNP-BC
• Laura B Connerley, PT, DPT

• Community/Retail Pharmacy in Southaven, MS
• Providers in Southaven, 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 Nov 11, 2022; 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.