Provider Demographics
NPI:1013558824
Name:DOWNHOME PHARMACY, INC.
Entity Type:Organization
Organization Name:DOWNHOME PHARMACY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:E
Authorized Official - Last Name:CRANE
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:601-756-2001
Mailing Address - Street 1:606 WEST BROAD ST
Mailing Address - Street 2:PO BOX 877
Mailing Address - City:MONTICELLO
Mailing Address - State:MS
Mailing Address - Zip Code:39654-0877
Mailing Address - Country:US
Mailing Address - Phone:601-695-0210
Mailing Address - Fax:601-833-7174
Practice Address - Street 1:606 W. BROAD ST
Practice Address - Street 2:
Practice Address - City:MONTICELLO
Practice Address - State:MS
Practice Address - Zip Code:39654
Practice Address - Country:US
Practice Address - Phone:601-756-2001
Practice Address - Fax:833-481-3377
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-02
Last Update Date:2022-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy