SPORTS MEDICINE PHARMACY LLC (NPI# 1912452921) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1912452921 |
| Entity Type | Organization |
| Organization Name | SPORTS MEDICINE PHARMACY LLC |
| Other Organization Name | SPORTS MEDICINE PHARMACY |
| Practice Address |
1325 E Fortification St Jackson MS 39202-2442 |
| Mailing Address |
1325 E Fortification St Po Box 16870 Jackson MS 39202-2442 |
| Practice Telephone | 6013544488 |
| Practice Fax Number | 7697776390 |
| Mailing Telephone | 6013544488 |
| Mailing Fax Number | 7697776390 |
| Enumeration Date | 2016-08-19 |
| Last Update Date | 2017-01-13 |
| Authorized Official Name | RANDY CALVERT (REGISTERED PHARMACIST) |
| Authorized Official Telephone | 6016721534 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 3336C0002X |
Pharmacy Specialization: Clinic Pharmacy |
Suppliers | ||
| N | 3336C0003X |
Pharmacy Specialization: Community/Retail Pharmacy |
Suppliers | ||
| Y | 333600000X | Pharmacy | 14908 | MS | Suppliers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MS | 06600515 | 05 | |
| PK | 2162491 | 01 |
| Other Name | Type Code |
|---|---|
| Sports Medicine Pharmacy | Doing Business As Name - Organization |
| Street Address |
1325 E FORTIFICATION ST |
| City | JACKSON |
| State | MS |
| Zip Code | 39202-2442 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1386632560 | Chris Phillip Ethridge | Orthopaedic Surgery | 1325 E Fortification St, Jackson, MS 39202-2442 | 2005-10-11 |
| 1144832130 | Georgiana Ogletree | Occupational Therapist | 1325 E Fortification St, Jackson, MS 39202-2442 | 2020-08-20 |
| 1972133353 | Justin Bryant Schopp | Physician Assistant | 1325 E Fortification St, Jackson, MS 39202-2442 | 2020-01-24 |
| 1154951739 | Hailey Daniels Kelly | Physician Assistant | 1325 E Fortification St, Jackson, MS 39202-2442 | 2020-01-22 |
| 1356903520 | James Logan Ferrell | Occupational Therapist | 1325 E Fortification St, Jackson, MS 39202-2442 | 2019-07-08 |
| 1184185472 | Jamie Jackson Garrett | Physician Assistant | 1325 E Fortification St, Jackson, MS 39202-2442 | 2019-03-28 |
| 1114494754 | Charles Taylor Knapp | Nurse Practitioner | 1325 E Fortification St, Jackson, MS 39202-2442 | 2018-11-01 |
| 1477078277 | Leah Winstead West | Physical Medicine & Rehabilitation | 1325 E Fortification St, Jackson, MS 39202-2442 | 2017-08-14 |
| 1700309374 | Van Treece Woodall | Specialist/Technologist | 1325 E Fortification St, Jackson, MS 39202-2442 | 2017-07-25 |
| 1346760220 | Megan Wallace Tyson | Nurse Practitioner | 1325 E Fortification St, Jackson, MS 39202-2442 | 2017-06-22 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1982234183 | Eva Mackenzie Carmody | Physician Assistant | 1190 N State St Suite 502, Jackson, MS 39202 | 2020-01-16 |
| 1750868691 | Katherine Walters | Nurse Practitioner | 501 Marshall St., Suite 400, Jackson, MS 39202 | 2018-07-24 |
| 1932638749 | Tylan Lee | Social Worker | 860 East River Place Suite 100, Jackson, MS 39202 | 2017-06-06 |
| 1417314725 | Euna Jyles | Counselor | 860 E River Pl, Jackson, MS 39202 | 2016-01-19 |
| 1255712048 | Edward Jonathan Breight | Specialist/Technologist | 1325 East Fortication Street, Jackson, MS 39202 | 2015-06-17 |
| 1881037703 | Kara Spinks Logan | Surgery | 1190 N State St Ste 502, Jackson, MS 39202 | 2013-04-10 |
| 1477876530 | Mick Inc. | Technician | 334 Josanna Street, Suite #209, Jackson, MS 39202 | 2010-03-03 |
| 1073724910 | Paul Frederic Dare | Anesthesiology | 1151 North State St., Suite 311, Jackson Anesthesia Associates, Jackson, MS 39202 | 2007-05-24 |
| 1225247703 | Lynn Kincannon Holland | Counselor | 911 Manship Street, Unit A, Jackson, MS 39202 | 2007-05-22 |
| 1457568149 | Incare Inc | Pulmonary Function Technologist | 1151 North State St, Suite 406, Jackson, MS 39202 | 2007-05-16 |
| Find all providers in zip 39202 | ||||
| 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 |
|---|---|---|---|---|
| 1942847413 | Southeast Hospital | Pharmacy | 2600 E. Main Street, Suite 113, Jackson, MO 63755 | 2019-12-04 |
| 1912409475 | Moyes Pharmacy Inc | Pharmacy | 227 S Mulberry St, Jackson, GA 30233-2058 | 2018-03-01 |
| 1619410321 | Red Cap Pharmacy 001 LLC | Pharmacy | 214 N West Ave Ste A, Jackson, MI 49201-1903 | 2016-11-29 |
| 1285050864 | Lewis Family Drug, LLC | Pharmacy | 825 3rd St, Jackson, MN 56143-1187 | 2014-03-06 |
| 1356664239 | Stone Drug | Pharmacy | 830 W Broadway, Jackson, WY 83002-9000 | 2010-03-08 |
| 1215053061 | Country Market Pharmacies, L.L.C. | Pharmacy | 1410 W Ganson St, Jackson, MI 49202-4063 | 2007-03-22 |
| 1851467823 | Costplus Pharmacy | Pharmacy | 104a W University Pkwy, Jackson, TN 38305-1635 | 2006-11-28 |
| 1205909777 | Brookshire Grocery Company | Pharmacy | 2861 Terry Rd, Attention Pharmacy Dept, Jackson, MS 39212-3051 | 2006-11-15 |
| 1396818860 | Brookshire Grocery Company | Pharmacy | 5841 Ridgewood Rd, Attention Pharmacy Dept, Jackson, MS 39211-2618 | 2006-11-15 |
| 1861564486 | Brents Drugs of Belhaven | Pharmacy | 902b E Fortification St, Jackson, MS 39202 | 2006-11-15 |
| Find all providers in JACKSON | ||||
Please comment or provide details below to improve the information on SPORTS MEDICINE PHARMACY LLC.
| 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.