Provider Demographics
NPI:1275951402
Name:OLDE TOWNE DRUGS, LTD.
Entity Type:Organization
Organization Name:OLDE TOWNE DRUGS, LTD.
Other - Org Name:OLDE TOWNE DRUGS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER, PRESIDENT, PHARMACIST IN CHA
Authorized Official - Prefix:DR
Authorized Official - First Name:ANNA
Authorized Official - Middle Name:CLAIRE
Authorized Official - Last Name:HEINDL
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:601-720-5775
Mailing Address - Street 1:1320 TRICKHAMBRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:MS
Mailing Address - Zip Code:39042-9213
Mailing Address - Country:US
Mailing Address - Phone:601-720-5775
Mailing Address - Fax:
Practice Address - Street 1:1645 W GOVERNMENT CV STE E
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:MS
Practice Address - Zip Code:39042-4602
Practice Address - Country:US
Practice Address - Phone:601-720-5775
Practice Address - Fax:601-825-2356
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-04
Last Update Date:2014-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS132803336C0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0004XSuppliersPharmacyCompounding Pharmacy