Provider Demographics
NPI:1346251857
Name:LARUE'S DISCOUNT DRUGS
Entity Type:Organization
Organization Name:LARUE'S DISCOUNT DRUGS
Other - Org Name:LARUE'S DISCOUNT DRUGS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LARUE
Authorized Official - Middle Name:
Authorized Official - Last Name:BAKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-833-7455
Mailing Address - Street 1:428 HIGHWAY 51 N
Mailing Address - Street 2:
Mailing Address - City:BROOKHAVEN
Mailing Address - State:MS
Mailing Address - Zip Code:39601-2351
Mailing Address - Country:US
Mailing Address - Phone:601-833-7455
Mailing Address - Fax:601-833-3987
Practice Address - Street 1:428 HIGHWAY 51 N
Practice Address - Street 2:
Practice Address - City:BROOKHAVEN
Practice Address - State:MS
Practice Address - Zip Code:39601-2351
Practice Address - Country:US
Practice Address - Phone:601-833-7455
Practice Address - Fax:601-833-3987
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-10
Last Update Date:2022-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
MSF022723336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2045343OtherPK
MS0030249Medicaid
0124490001Medicare NSC