Provider Demographics
NPI:1588132328
Name:MAC PHARMACEUTICALS LLC
Entity type:Organization
Organization Name:MAC PHARMACEUTICALS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ANESTHESIOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JOVIE
Authorized Official - Middle Name:N
Authorized Official - Last Name:BRIDGEWATER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:662-349-2659
Mailing Address - Street 1:391 SOUTHCREST CIR STE 108
Mailing Address - Street 2:
Mailing Address - City:SOUTHAVEN
Mailing Address - State:MS
Mailing Address - Zip Code:38671-4775
Mailing Address - Country:US
Mailing Address - Phone:662-349-2659
Mailing Address - Fax:662-349-2653
Practice Address - Street 1:391 SOUTHCREST CIR STE 108
Practice Address - Street 2:
Practice Address - City:SOUTHAVEN
Practice Address - State:MS
Practice Address - Zip Code:38671-4775
Practice Address - Country:US
Practice Address - Phone:662-349-2659
Practice Address - Fax:662-349-2653
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-09
Last Update Date:2020-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies