VICKSBURG SPECIAL CARE PHARMACY AND COMPOUNDING LLC
4079 Pemberton Square Blvd
Vicksburg, MS 39180
601-636-5555
Taxonomy:
Primary | Code | Category/Description | State | License Number |
---|---|---|---|---|
N | 333600000X | Suppliers - Pharmacy - | ||
Y | 3336C0003X | Suppliers - Pharmacy | MS | 08249/1.1 |
Other Provider Identifiers:
Issuer | Number | State | Type |
---|---|---|---|
123555 | LA | MEDICAID | |
PK | 2122108 | OTHER |