Provider Demographics
NPI:1093884025
Name:SOUTHERN DISCOUNT DRUGS OF CHARLESTON INC.
Entity Type:Organization
Organization Name:SOUTHERN DISCOUNT DRUGS OF CHARLESTON INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:L
Authorized Official - Last Name:SALMON
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:662-647-5172
Mailing Address - Street 1:109 W WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:MS
Mailing Address - Zip Code:38921-2242
Mailing Address - Country:US
Mailing Address - Phone:662-647-5172
Mailing Address - Fax:
Practice Address - Street 1:109 W WALNUT ST
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:MS
Practice Address - Zip Code:38921-2242
Practice Address - Country:US
Practice Address - Phone:662-647-5172
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-06
Last Update Date:2022-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSE05166183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00030144Medicaid
MS2512110OtherNAPB
MS01501/01.1OtherSTATE LICENSE NUMBER
MS00040385Medicaid
MS00040385Medicaid
MS00040385Medicaid