Provider Demographics
NPI:1649281288
Name:COPD PHARMACY CONSULTANTS LLC
Entity type:Organization
Organization Name:COPD PHARMACY CONSULTANTS LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST LLC MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:
Authorized Official - Last Name:CUTRER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-925-5822
Mailing Address - Street 1:132 FAIRMONT ST
Mailing Address - Street 2:SUITE C
Mailing Address - City:CLINTON
Mailing Address - State:MS
Mailing Address - Zip Code:39056-4721
Mailing Address - Country:US
Mailing Address - Phone:601-925-5822
Mailing Address - Fax:601-925-5812
Practice Address - Street 1:132 FAIRMONT ST
Practice Address - Street 2:STE C
Practice Address - City:CLINTON
Practice Address - State:MS
Practice Address - Zip Code:39056-4721
Practice Address - Country:US
Practice Address - Phone:601-925-5822
Practice Address - Fax:601-925-5812
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-10
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3336C0003X
MS05801025333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS02671273Medicaid
2521412OtherOTHER ID NUMBER-COMMERCIAL NUMBER
MS02671273Medicaid
MS=========OtherHUMANA