Provider Demographics
NPI:1003941386
Name:POINT REXALL DRUG
Entity Type:Organization
Organization Name:POINT REXALL DRUG
Other - Org Name:POINT REXALL DRUG
Other - Org Type:Other Name
Authorized Official - Title/Position:PHARMACIST MGR
Authorized Official - Prefix:MRS
Authorized Official - First Name:VIRGINIA
Authorized Official - Middle Name:SMITH
Authorized Official - Last Name:WILLIS
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:601-483-3367
Mailing Address - Street 1:2127 24TH AVE
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:MS
Mailing Address - Zip Code:39301
Mailing Address - Country:US
Mailing Address - Phone:601-483-3367
Mailing Address - Fax:601-482-3164
Practice Address - Street 1:2127 24TH AVE
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:MS
Practice Address - Zip Code:39301
Practice Address - Country:US
Practice Address - Phone:601-483-3367
Practice Address - Fax:601-482-3164
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS00123011183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty