OrganizationMagnolia Specialty Pharmacy Inc(Magnolia Specialty Pharmacy Inc.)PharmacySuppliersPractice Address16 Keystone Dr Ste B, Hattiesburg, MS 39402-6121(877) 871-3935PECOS EnrollmentBased on the most recent information from CMS, provider Magnolia Specialty Pharmacy Inc does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records yesterday at 11:47 AM.Profile DetailsProvider ID1720368541Provider TypeOrganizationFull NameMagnolia Specialty Pharmacy IncOther NameMagnolia Specialty Pharmacy Inc.SubpartNoEnumeration Date8/24/2011Last Updated4/11/2017Contact InformationPractice LocationPractice Address16 Keystone Dr Ste B, Hattiesburg, MS 39402-6121Phone(877) 871-3935Fax(888) 990-0575Mailing LocationMailing Address16 Keystone Dr Ste B, Hattiesburg, MS 39402-6121Phone(877) 871-3935Fax(888) 990-0575Authorized OfficialNameParker, David (President/Owner)Phone(601) 606-0252Provider TaxonomiesCodeDescriptionLicenseCode3336C0003XPrimaryDescriptionPharmacySuppliersLicense09087MississippiCode3336C0004XDescriptionPharmacySuppliersLicenseUnlisted IssuerProvider IdentifiersIDDescriptionIssuerID2131699DescriptionOtherIssuerPK