Thirteenth Avenue Pharmacy

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

01527 Issued in MS

Legal business name

THIRTEENTH AVENUE PHARMACY

Practice address

216 S 13TH Ave
Laurel, MS 39440-4226

Phone

(601) 428-7257

NPI assigned

Apr 12, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Kyle Mauldin, R.PH.

Title

Owner Pharmacist

Phone

(601) 428-7257

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1176336000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1689898579",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "216 S 13TH AVE",
            "city": "LAUREL",
            "state": "MS",
            "postal_code": "394404226",
            "telephone_number": "601-428-7257"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "216 S 13TH AVE",
            "city": "LAUREL",
            "state": "MS",
            "postal_code": "394404226",
            "telephone_number": "601-428-7257"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THIRTEENTH AVENUE PHARMACY",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-12",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "MAULDIN",
        "authorized_official_first_name": "KYLE",
        "authorized_official_title_or_position": "OWNER PHARMACIST",
        "authorized_official_telephone_number": "601-428-7257",
        "authorized_official_credential": "R.PH."
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "MS",
            "license": "01527",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00330499",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Community/Retail Pharmacy in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.