Provider Demographics
NPI:1861727588
Name:CAMELLIA PHARMACY SERVICES LLC
Entity type:Organization
Organization Name:CAMELLIA PHARMACY SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST IN CHARGE
Authorized Official - Prefix:
Authorized Official - First Name:BILLY
Authorized Official - Middle Name:
Authorized Official - Last Name:EVERETT
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:601-863-1300
Mailing Address - Street 1:885 LIBERTY RD STE 500
Mailing Address - Street 2:
Mailing Address - City:FLOWOOD
Mailing Address - State:MS
Mailing Address - Zip Code:39232-9000
Mailing Address - Country:US
Mailing Address - Phone:601-714-1868
Mailing Address - Fax:601-420-6866
Practice Address - Street 1:885 LIBERTY RD STE 500
Practice Address - Street 2:
Practice Address - City:FLOWOOD
Practice Address - State:MS
Practice Address - Zip Code:39232-9000
Practice Address - Country:US
Practice Address - Phone:601-714-1868
Practice Address - Fax:601-420-6866
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-14
Last Update Date:2021-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251F00000X, 332B00000X, 333600000X, 3336S0011X
MS08271/2.03336H0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
No251F00000XAgenciesHome Infusion
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2122571OtherPK
MS00329571Medicaid