Provider Demographics
NPI:1275643207
Name:DUTCH PHARMACIES INC
Entity Type:Organization
Organization Name:DUTCH PHARMACIES INC
Other - Org Name:FAMILY PHARMACY #1
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:KIN
Authorized Official - Middle Name:
Authorized Official - Last Name:SETO
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:662-329-9060
Mailing Address - Street 1:PO BOX 5052
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:MS
Mailing Address - Zip Code:39704-5052
Mailing Address - Country:US
Mailing Address - Phone:662-329-9060
Mailing Address - Fax:662-329-9061
Practice Address - Street 1:1245 N LEHMBERG RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:MS
Practice Address - Zip Code:39702-3224
Practice Address - Country:US
Practice Address - Phone:662-329-9060
Practice Address - Fax:662-329-9061
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2015-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSE-6863183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL100230078Medicaid
MS0030218Medicaid