Provider Demographics
NPI:1164497475
Name:S & S PHARMACY INC
Entity Type:Organization
Organization Name:S & S PHARMACY INC
Other - Org Name:RX EXPRESS PHARMACY OF PASCAGOULA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST / PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:HOLSTON
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:228-762-5664
Mailing Address - Street 1:2952 MARKET ST
Mailing Address - Street 2:
Mailing Address - City:PASCAGOULA
Mailing Address - State:MS
Mailing Address - Zip Code:39567-5163
Mailing Address - Country:US
Mailing Address - Phone:228-762-5664
Mailing Address - Fax:228-762-5625
Practice Address - Street 1:2952 MARKET ST
Practice Address - Street 2:
Practice Address - City:PASCAGOULA
Practice Address - State:MS
Practice Address - Zip Code:39567-5163
Practice Address - Country:US
Practice Address - Phone:228-762-5664
Practice Address - Fax:228-762-5625
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-21
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS0242601.1333600000X
MS3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS2517677OtherNCPDP
MS00330082Medicaid
MSBT3743300OtherDEA #
MS00330082Medicaid