Northeast Mental Health Mental Retardation Commission

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

07162/5.2 Issued in MS

Legal business name

NORTHEAST MENTAL HEALTH MENTAL RETARDATION COMMISSION

Doing business as

Lifecore Pharmacy, Amory

Practice address

317 Main St N
Amory, MS 38821-3420

Phone

(662) 634-4347

Fax

(662) 256-5567

NPI assigned

Jan 3, 2007

Last updated

Jul 19, 2018By 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

Van Watson, BS OF PHARMACY

Title

VP of Pharmacy Division

Phone

(662) 634-4347

Specialties & licenses 2

Addresses

Other identifiers 2

Other names 1

• LIFECORE PHARMACY, AMORY Doing business as

Tax ID family

Northeast Mental Healthmental Retardation Commission2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

• Northeast Mental Health-Mental Retardation Commission

  dba Lifecore Pharmacy Tupelo

  • Community/Retail Pharmacy
  • Tupelo, MS
  • NPI 1427489517
  NPD tax ID

Locations

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

{
    "created_epoch": "1167782400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1531958400000",
    "number": "1982761367",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "317 MAIN ST N",
            "city": "AMORY",
            "state": "MS",
            "postal_code": "388213420",
            "telephone_number": "662-634-4347",
            "fax_number": "662-256-5567"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "317 MAIN ST N",
            "city": "AMORY",
            "state": "MS",
            "postal_code": "388213420",
            "telephone_number": "662-634-4347",
            "fax_number": "662-256-5567"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHEAST MENTAL HEALTH MENTAL RETARDATION COMMISSION",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-03",
        "last_updated": "2018-07-19",
        "status": "A",
        "authorized_official_last_name": "WATSON",
        "authorized_official_first_name": "VAN",
        "authorized_official_title_or_position": "VP OF PHARMACY DIVISION",
        "authorized_official_telephone_number": "662-634-4347",
        "authorized_official_credential": "BS OF PHARMACY"
    },
    "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": "07162/5.2",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "05123737",
            "state": "MS"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2047457",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "LIFECORE PHARMACY, AMORY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• North Mississippi Gilmore Clinics, LLC (Amory Medical Clinic)
• North Mississippi Gilmore Clinics, LLC (Amory Specialty Clinic)
• North Mississippi Gilmore Clinics, LLC
• North Mississippi Gilmore Clinics, LLC (Amory Pathology)
• North Mississippi Gilmore Clinics, LLC (Amory Childrens Clinic)
• Oaktree Manor Assisted Living, Inc.
• Terry William Odom, M.D.
• Ortho Express Holding Company, LLC (OrthoXpress Bone & Joint Center of Amory)
• Orthopaedic Institute of North Mississippi, LLC
• Stephen K Otey, MD

• Community/Retail Pharmacy in Amory, MS
• Providers in Amory, 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 Jul 19, 2018; 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.