Vicksburg Special Care Pharmacy and Compounding LLC

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

08249/1.1 Issued in MS

Legal business name

VICKSBURG SPECIAL CARE PHARMACY AND COMPOUNDING LLC

Doing business as

Aspire Rx

Practice address

4079 Pemberton Square Blvd
Vicksburg, MS 39180-5580

Phone

(601) 636-5555

Fax

(601) 638-1564

NPI assigned

Oct 8, 2009

Last updated

Oct 7, 2016By 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

Jason Rutland, PHARM D

Title

MGR

Phone

(601) 983-1239

Specialties & licenses 2

Addresses

Other identifiers 2

Other names 1

• Aspire Rx Doing business as

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

{
    "created_epoch": "1254960000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1475798400000",
    "number": "1659606663",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1485 LIVINGSTON LN",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "392138004",
            "telephone_number": "601-326-7347",
            "fax_number": "601-982-7103"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4079 PEMBERTON SQUARE BLVD",
            "city": "VICKSBURG",
            "state": "MS",
            "postal_code": "391805580",
            "telephone_number": "601-636-5555",
            "fax_number": "601-638-1564"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VICKSBURG SPECIAL CARE PHARMACY AND COMPOUNDING LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-10-08",
        "last_updated": "2016-10-07",
        "status": "A",
        "authorized_official_last_name": "RUTLAND",
        "authorized_official_first_name": "JASON",
        "authorized_official_title_or_position": "MGR",
        "authorized_official_telephone_number": "601-983-1239",
        "authorized_official_credential": "PHARM D"
    },
    "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": "08249/1.1",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2122108",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "123555",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Aspire Rx",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Vicksburg Nephrology LLC
• Vicksburg Orthodontics LLC
• Vicksburg Pathology Laboratory
• Vicksburg Primary Care Team Inc
• Vicksburg Special Care Clinic LLC
• Vicksburg Spine Center, LLC
• Vicksburg Surgical Associates, PA
• Vicksburg Warren School District
• Vicksburg Women's Care, Inc
• Vine Medical Associates LLC

• Community/Retail Pharmacy in Vicksburg, MS
• Providers in Vicksburg, 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 Oct 7, 2016; 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.