Provider Demographics
NPI:1053315671
Name:DIAMONDHEAD PHARMACY & GIFTS, INC
Entity Type:Organization
Organization Name:DIAMONDHEAD PHARMACY & GIFTS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:RUSSELL
Authorized Official - Last Name:LOVE
Authorized Official - Suffix:SR
Authorized Official - Credentials:RPH
Authorized Official - Phone:228-255-7343
Mailing Address - Street 1:4422 KALANI DR
Mailing Address - Street 2:
Mailing Address - City:DIAMONDHEAD
Mailing Address - State:MS
Mailing Address - Zip Code:39525-3321
Mailing Address - Country:US
Mailing Address - Phone:228-255-7343
Mailing Address - Fax:228-255-1748
Practice Address - Street 1:4422 KALANI DR
Practice Address - Street 2:
Practice Address - City:DIAMONDHEAD
Practice Address - State:MS
Practice Address - Zip Code:39525-3321
Practice Address - Country:US
Practice Address - Phone:228-255-7343
Practice Address - Fax:228-255-1748
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS021130113336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy