NPIMap

Organization Active NPI

Midsouth Medical Specialties, LLC

Doing business as Grace Apothecary

  • Compounding Pharmacy
  • Hernando, MS
National Provider Identifier
1992139711
Registry record updated Aug 28, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Compounding PharmacyTaxonomy code 3336C0004X
Legal business name
MIDSOUTH MEDICAL SPECIALTIES, LLC
Doing business as
Grace Apothecary
Practice address
185 W Center St
Hernando, MS 38632-2268
Phone
(901) 262-4317
Fax
(662) 510-0268
NPI assigned
Aug 28, 2013
Last updated
Aug 28, 2013By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 28, 2013

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

Authorized official

Name
Eddie D O'Bannon, PHARM D
Title
Owner
Phone
(901) 262-4317

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Compounding Pharmacy 3336C0004X NU Primary

Addresses

Primary practice location

185 W Center St
Hernando, MS 38632-2268

Mailing address

PO Box 563
Hernando, MS 38632-0563
Phone (901) 262-4317

Other names 1

  • Grace Apothecary 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.

NPI Registry JSON

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

{
    "created_epoch": "1377648000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1377648000000",
    "number": "1992139711",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 563",
            "city": "HERNANDO",
            "state": "MS",
            "postal_code": "386320563",
            "telephone_number": "901-262-4317",
            "fax_number": "662-510-0268"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "185 W CENTER ST",
            "city": "HERNANDO",
            "state": "MS",
            "postal_code": "386322268",
            "telephone_number": "901-262-4317",
            "fax_number": "662-510-0268"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MIDSOUTH MEDICAL SPECIALTIES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-08-28",
        "last_updated": "2013-08-28",
        "status": "A",
        "authorized_official_last_name": "O'BANNON",
        "authorized_official_first_name": "EDDIE",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "901-262-4317",
        "authorized_official_credential": "PHARM D"
    },
    "taxonomies": [
        {
            "code": "3336C0004X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Compounding Pharmacy",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Grace Apothecary",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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 Aug 28, 2013; 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.