Provider Demographics
NPI:1285177394
Name:FORMULAONE PHARMACEUTICALS, LLC
Entity type:Organization
Organization Name:FORMULAONE PHARMACEUTICALS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:MRS
Authorized Official - First Name:TINA
Authorized Official - Middle Name:
Authorized Official - Last Name:LITTLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:662-594-1594
Mailing Address - Street 1:127 PRATT DR
Mailing Address - Street 2:
Mailing Address - City:CORINTH
Mailing Address - State:MS
Mailing Address - Zip Code:38834-6026
Mailing Address - Country:US
Mailing Address - Phone:662-594-1594
Mailing Address - Fax:662-594-1864
Practice Address - Street 1:127 PRATT DR
Practice Address - Street 2:
Practice Address - City:CORINTH
Practice Address - State:MS
Practice Address - Zip Code:38834-6026
Practice Address - Country:US
Practice Address - Phone:662-594-1594
Practice Address - Fax:662-594-1864
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-21
Last Update Date:2016-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336I0012XSuppliersPharmacyInstitutional Pharmacy