MISSISSIPPI CVS PHARMACY LLC (NPI# 1740682210) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1740682210 |
| Entity Type | Organization |
| Organization Name | MISSISSIPPI CVS PHARMACY LLC |
| Other Organization Name | CVS PHARMACY # 10400 |
| Practice Address |
1435 N. Frontage Rd Vicksburg MS 39180-5170 |
| Mailing Address |
1 Cvs Dr Box 1075 Woonsocket RI 02895-6146 |
| Practice Telephone | 6016619652 |
| Mailing Telephone | 4017651500 |
| Enumeration Date | 2014-09-16 |
| Last Update Date | 2015-04-06 |
| Authorized Official Name | SUSAN F COLBERT (DIRECTOR) |
| Authorized Official Telephone | 4017651500 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 332B00000X | Durable Medical Equipment & Medical Supplies | Suppliers | ||
| N | 3336C0003X |
Pharmacy Specialization: Community/Retail Pharmacy |
Suppliers | ||
| Y | 333600000X | Pharmacy | Suppliers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MS | NCPDP | 2589907 | 01 |
| MS | 09752075 RX | 05 |
| Other Name | Type Code |
|---|---|
| CVS PHARMACY # 10400 | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1710314463 | Mississippi Cvs Pharmacy LLC | Durable Medical Equipment & Medical Supplies | 365 Cole Rd, Hattiesburg, MS 39402 | 2013-09-26 |
| 1770826158 | Mississippi Cvs Pharmacy LLC | Durable Medical Equipment & Medical Supplies | 801 Highway 80 E, Clinton, MS 39056-5252 | 2013-04-03 |
| 1942562533 | Mississippi Cvs Pharmacy LLC | Durable Medical Equipment & Medical Supplies | 12024 Lamey Bridge Rd, Diberville, MS 39540-8906 | 2012-06-11 |
| 1922366756 | Mississippi Cvs Pharmacy LLC | Durable Medical Equipment & Medical Supplies | 1912 Jackson Ave W, Oxford, MS 38655-4454 | 2012-04-30 |
| 1356618979 | Mississippi Cvs Pharmacy LLC | Durable Medical Equipment & Medical Supplies | 800 E Fifteenth St, Yazoo City, MS 39194-7625 | 2011-11-28 |
| 1366735185 | Mississippi Cvs Pharmacy LLC | Durable Medical Equipment & Medical Supplies | 2507 Hardy St, Hattiesburg, MS 39401-5914 | 2011-05-26 |
| 1598054082 | Mississippi Cvs Pharmacy LLC | Durable Medical Equipment & Medical Supplies | 750 City Ave S, Ripley, MS 38663-2520 | 2011-04-05 |
| 1730311689 | Mississippi Cvs Pharmacy LLC | Pharmacy | 3867 Promenade Pkwy, Diberville, MS 39540-5372 | 2009-08-11 |
| 1528229614 | Mississippi Cvs Pharmacy LLC | Pharmacy | 5150 Goodman Rd, Olive Branch, MS 38654-7903 | 2008-06-20 |
| 1174798417 | Mississippi Cvs Pharmacy LLC | Durable Medical Equipment & Medical Supplies | 6040 Goodman Rd, Walls, MS 38680 | 2008-04-28 |
| Street Address |
1435 N. FRONTAGE RD |
| City | VICKSBURG |
| State | MS |
| Zip Code | 39180-5170 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1255877346 | Elite Performance and Rehab, LLC | Clinic/Center | 1901 A Mission 66, Vicksburg, MS 39180 | 2017-01-12 |
| 1679931083 | Heather M Anderson | Physician Assistant | 2080 S Frontage Rd Ste 100, Vicksburg, MS 39180 | 2016-02-01 |
| 1245604941 | Warren County Assn.for Retarded Citizens, Inc. | Day Training, Developmentally Disabled Services | 100 Smokey Lane, Vicksburg, MS 39180 | 2015-11-18 |
| 1386012904 | Brian Oliver Snowden | Counselor | 3530 Manor Dr Ste 5a, Vicksburg, MS 39180 | 2015-09-14 |
| 1962802710 | Jordan P. Crocker, D.m.d., Pllc | Clinic/Center | 109 Monument Place, Vicksburg, MS 39180 | 2014-08-29 |
| 1821434259 | Trisha Addison | Physical Therapist | 2222 South Frontage Road, Suite D, Vicksburg, MS 39180 | 2013-05-13 |
| 1073862157 | Laura Jeanne Briggs | Physical Therapist | 1901-a Mission 66, Vicksburg, MS 39180 | 2012-09-05 |
| 1912175258 | Andrea T. Harris | Counselor | Warren-yazoo Mental Health Service, 3444 Wisconsin Ave., Vicksburg, MS 39180 | 2008-02-20 |
| 1922217314 | Austin Family Dentistry | Dentist | 3040 Indiana Ave, Vicksburg, MS 39180 | 2007-05-22 |
| 1063539138 | Ollie Hardaway Jr. | Dentist | 154 Cottonwood Street, Vicksburg, MS 39180 | 2007-03-23 |
| Find all providers in zip 39180 | ||||
| Taxonomy Code | 333600000X |
| Grouping | Suppliers |
| Classification | Pharmacy |
| A facility used by pharmacists for the compounding and dispensing of medicinal preparations and other associated professional and administrative services. A pharmacy is a facility whose primary function is to store, prepare and legally dispense prescription drugs under the professional supervision of a licensed pharmacist. It meets any licensing or certification standards set forth by the jurisdiction where it is located. |
| Notes: Source: Developed by National Council for Prescription Drug Programs (NCPDP), National Home Infusion Association (NHIA), and Pharmacist Services Technical Advisory Coalition (PSTAC) [1/1/2006: added definition] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1972925303 | Reliant Medical LLC | Pharmacy | 3532 Manor Dr Ste 4, Vicksburg, MS 39180-5629 | 2014-01-21 |
| 1659606663 | Vicksburg Special Care Pharmacy and Compounding LLC | Pharmacy | 4079 Pemberton Square Blvd, Vicksburg, MS 39180-5580 | 2009-10-08 |
| 1912048646 | Amt Group LLC | Pharmacy | 1670 Highway 61 N, Vicksburg, MS 39183-3411 | 2007-02-08 |
| 1376601492 | Superco Inc | Pharmacy | 3040a Indiana Ave, Vicksburg, MS 39180-4355 | 2006-12-04 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1457973067 | Thomas Street Compounding Pharmacy | Pharmacy | 115 N Thomas St Ste G, Tupelo, MS 38801-3082 | 2020-05-18 |
| 1013558824 | Downhome Pharmacy, Inc. | Pharmacy | 606 W. Broad St, Monticello, MS 39654 | 2019-10-02 |
| 1356997985 | Sonshine Pharmacy, LLC | Pharmacy | 2745 Highway 371 N, Mantachie, MS 38855 | 2019-08-09 |
| 1699331868 | Fulton Specialty Pharmacy, LLC | Pharmacy | 1509 S Adams St Ste D, Fulton, MS 38843-6621 | 2019-05-14 |
| 1063971539 | National Pharmacy of Mississippi, LLC | Pharmacy | 371b Highland Colony Pkwy, Ridgeland, MS 39157-6035 | 2019-03-14 |
| 1811468952 | Davidson Pharmacy, LLC | Pharmacy | 203a N 2nd St, Booneville, MS 38829-2701 | 2018-12-16 |
| 1346710720 | Tupelo Specialty Pharmacy, LLC | Pharmacy | 1056 Cliff Gookin Blvd Ste C, Tupelo, MS 38801-6458 | 2018-11-28 |
| 1205302254 | A & A Infusion & Specialty, LLC | Pharmacy | 423 Mcallister St, Greenville, MS 38701-4704 | 2018-10-17 |
| 1306325402 | Family Drug Mart of Poplarville,llc | Pharmacy | 100 Highway 11 N, Poplarville, MS 39470-2217 | 2018-08-09 |
| 1851883789 | Amory Discount Pharmacy, LLC | Pharmacy | 60379 Cotton Gin Port Rd Ste B, Amory, MS 38821-7204 | 2018-06-06 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.