NPIMap

Organization Active NPI

Midsouth Medical Specialties LLC

Doing business as Super Drugs

  • Community/Retail Pharmacy
  • Horn Lake, MS
National Provider Identifier
1932864667
Registry record updated Nov 8, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
Legal business name
MIDSOUTH MEDICAL SPECIALTIES LLC
Doing business as
Super Drugs
Practice address
1433 Goodman Rd W
Horn Lake, MS 38637-1404
Phone
(901) 674-3148
NPI assigned
Nov 8, 2021
Last updated
Nov 8, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 8, 2021

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

Authorized official

Name
Jake O'Bannon
Title
Pharmacist
Phone
(662) 280-7455

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Retail Pharmacy 3336C0003X Primary
Compounding Pharmacy 3336C0004X

Addresses

Primary practice location

1433 Goodman Rd W
Horn Lake, MS 38637-1404

Mailing address

1433 Goodman Rd W
Horn Lake, MS 38637-1404
Phone (662) 280-7455

Other identifiers 1

IdentifierTypeStateIssuer
02434788MedicaidMS

Other names 1

  • Super Drugs Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Misdouth Medical Specialties LLC5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

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

Locations

1433 Goodman Rd W
Horn Lake, MS 38637
Phone (662) 280-3535

NPI Registry JSON

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

{
    "created_epoch": "1636329600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1636329600000",
    "number": "1932864667",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1433 GOODMAN RD W",
            "city": "HORN LAKE",
            "state": "MS",
            "postal_code": "386371404",
            "telephone_number": "662-280-7455"
        },
        {
            "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": "386371404",
            "telephone_number": "901-674-3148"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MIDSOUTH MEDICAL SPECIALTIES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-11-08",
        "last_updated": "2021-11-08",
        "certification_date": "2021-11-08",
        "status": "A",
        "authorized_official_last_name": "O'BANNON",
        "authorized_official_first_name": "JAKE",
        "authorized_official_title_or_position": "PHARMACIST",
        "authorized_official_telephone_number": "662-280-7455"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "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"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Super Drugs",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Super Drugs",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Horn Lake, MS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 8, 2021; 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.