Provider Demographics
NPI:1063472793
Name:BIGGS DRUGSTORE
Entity Type:Organization
Organization Name:BIGGS DRUGSTORE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHARMACIST
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:SPELL
Authorized Official - Suffix:JR
Authorized Official - Credentials:RPH
Authorized Official - Phone:601-892-4061
Mailing Address - Street 1:101 E GEORGETOWN ST
Mailing Address - Street 2:
Mailing Address - City:CRYSTAL SPRINGS
Mailing Address - State:MS
Mailing Address - Zip Code:39059-2777
Mailing Address - Country:US
Mailing Address - Phone:601-892-4061
Mailing Address - Fax:601-892-6055
Practice Address - Street 1:101 E GEORGETOWN ST
Practice Address - Street 2:
Practice Address - City:CRYSTAL SPRINGS
Practice Address - State:MS
Practice Address - Zip Code:39059-2777
Practice Address - Country:US
Practice Address - Phone:601-892-4061
Practice Address - Fax:601-892-6055
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-25
Last Update Date:2008-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X
MS00613/01.1333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00030414Medicaid
MS00030414Medicaid