UNIVERSITY PAVILION PHARMACY; NPI #1417090093

Contact Information

UNIVERSITY PAVILION PHARMACY

1410 E WOODROW WILSON DR
JACKSON, MS 39216

Phone: 601-984-2058
Fax: 601-984-2063
Website:

	Specialty	Taxonomy Code	Specialty Code	Provider Type
	Clinic Pharmacy	3336C0002X	58	Medical Supply Company with Pharmacist

Indicates primary specialty

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NPI Profile & details for UNIVERSITY PAVILION PHARMACY

NPI Number 1417090093

LBN Legal business name UNIVERSITY PAVILION PHARMACY

Authorized official SUSAN COBB - (PHARMACY SUPERVISOR)

Entity Organization

Organization subpart ¹ No

Enumeration date 02/14/2007

Last updated 09/07/2007 - About 19 years ago

Identifiers

MS	License #	02188
MS	Medicaid	30158

¹ Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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