NPIMap

Organization Active NPI

Region IV Desoto County Pharmacy

  • Community/Retail Pharmacy
  • Hernando, MS
National Provider Identifier
1689915423
Registry record updated Jun 6, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
Legal business name
REGION IV DESOTO COUNTY PHARMACY
Practice address
2705 Highway 51 S
Hernando, MS 38632-2634
Phone
(662) 449-4025
Fax
(662) 429-3546
NPI assigned
Mar 4, 2013
Last updated
Jun 6, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 6, 2025

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

Authorized official

Name
Jason Ramey
Title
Executive Director
Phone
(662) 286-9883

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic Pharmacy 3336C0002X NU
Community/Retail Pharmacy 3336C0003X NU Primary

Addresses

Primary practice location

2705 Highway 51 S
Hernando, MS 38632-2634

Mailing address

2705 Highway 51 S
Hernando, MS 38632-2634
Phone (662) 286-9883

Other identifiers 1

IdentifierTypeStateIssuer
09421377MedicaidMS

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MS

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20130523000378 MS Part B Supplier - Pharmacy 4688733991 Practice locations: Hernando, MS

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory
Tax ID family
Region IV Mental Health Services Crisis Center-Corinth31 organizations share this tax ID, including this one

Other organizations with this tax ID 30

Organizations that report the same tax identification number in the National Provider Directory.

View all 30

Locations

2100 E Chambers Dr
Booneville, MS 38829
Phone (662) 728-3137

2100 E Chambers Dr
#1975
Booneville, MS 38829
Phone (662) 287-4424

2301 E Chambers Dr
Booneville, MS 38829
Phone (662) 720-4816

1000 State St
Corinth, MS 38834
Phone (662) 286-5469

601 Foote St
#1975
Corinth, MS 38834
Phone (662) 287-4424

Practitioners & affiliated clinicians

Practitioners 42

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 42

NPI Registry JSON

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

{
    "created_epoch": "1362355200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1749168000000",
    "number": "1689915423",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2705 HIGHWAY 51 S",
            "city": "HERNANDO",
            "state": "MS",
            "postal_code": "386322634",
            "telephone_number": "662-286-9883"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2705 HIGHWAY 51 S",
            "city": "HERNANDO",
            "state": "MS",
            "postal_code": "386322634",
            "telephone_number": "662-449-4025",
            "fax_number": "662-429-3546"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "REGION IV DESOTO COUNTY PHARMACY",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-03-04",
        "last_updated": "2025-06-06",
        "certification_date": "2025-06-06",
        "status": "A",
        "authorized_official_last_name": "RAMEY",
        "authorized_official_first_name": "JASON",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "662-286-9883"
    },
    "taxonomies": [
        {
            "code": "3336C0002X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Clinic Pharmacy",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "09421377",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Hernando, MS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 6, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.