Provider Demographics
NPI:1235205154
Name:ASHLAND DRUGS INC
Entity Type:Organization
Organization Name:ASHLAND DRUGS INC
Other - Org Name:ASHLAND DISCOUNT DRUG
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER PHARMACIST
Authorized Official - Prefix:MR
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:H
Authorized Official - Last Name:MELTON
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:662-224-8922
Mailing Address - Street 1:PO BOX 126
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:MS
Mailing Address - Zip Code:38603
Mailing Address - Country:US
Mailing Address - Phone:662-224-8922
Mailing Address - Fax:662-224-9111
Practice Address - Street 1:15917 BOUNDARY DRIVE
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:MS
Practice Address - Zip Code:38603
Practice Address - Country:US
Practice Address - Phone:662-224-8922
Practice Address - Fax:662-224-9111
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-24
Last Update Date:2022-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS015303336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00030186Medicaid
MS00045127Medicaid
MS5878520001Medicare NSC