Provider Demographics
NPI:1285856740
Name:MCDUFFIE DRUG CO.
Entity Type:Organization
Organization Name:MCDUFFIE DRUG CO.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:TRAVIS
Authorized Official - Last Name:HALL
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:662-963-2367
Mailing Address - Street 1:PO BOX 389
Mailing Address - Street 2:
Mailing Address - City:NETTLETON
Mailing Address - State:MS
Mailing Address - Zip Code:38858-0389
Mailing Address - Country:US
Mailing Address - Phone:662-963-2367
Mailing Address - Fax:662-963-2392
Practice Address - Street 1:174 A YOUNG AVE.
Practice Address - Street 2:
Practice Address - City:NETTLETON
Practice Address - State:MS
Practice Address - Zip Code:38858-0389
Practice Address - Country:US
Practice Address - Phone:662-963-2367
Practice Address - Fax:662-963-2392
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2008-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS00489 01.13336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy