Provider Demographics
NPI:1275625543
Name:PEOPLE'S DRUG STORE, INC
Entity Type:Organization
Organization Name:PEOPLE'S DRUG STORE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:F
Authorized Official - Last Name:BOVE
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:601-636-5214
Mailing Address - Street 1:1521 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:VICKSBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39180-3539
Mailing Address - Country:US
Mailing Address - Phone:601-636-5214
Mailing Address - Fax:601-636-5272
Practice Address - Street 1:1521 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:VICKSBURG
Practice Address - State:MS
Practice Address - Zip Code:39180-3539
Practice Address - Country:US
Practice Address - Phone:601-636-5214
Practice Address - Fax:601-636-5272
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-28
Last Update Date:2008-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS00285/01.1332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00440696Medicaid
MS00440696Medicaid