Provider Demographics
NPI:1376193193
Name:COX-BLYTHE HEALTHCARE GROUP CORP
Entity Type:Organization
Organization Name:COX-BLYTHE HEALTHCARE GROUP CORP
Other - Org Name:COX-BLYTHE DRUG COMPANY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST IN CHARGE/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AUDRA
Authorized Official - Middle Name:B
Authorized Official - Last Name:ARMISTEAD
Authorized Official - Suffix:
Authorized Official - Credentials:REGISTERED PHARMACIS
Authorized Official - Phone:662-728-5732
Mailing Address - Street 1:122 W COLLEGE ST
Mailing Address - Street 2:
Mailing Address - City:BOONEVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:38829-3498
Mailing Address - Country:US
Mailing Address - Phone:662-728-5732
Mailing Address - Fax:662-728-5756
Practice Address - Street 1:122 W COLLEGE ST
Practice Address - Street 2:
Practice Address - City:BOONEVILLE
Practice Address - State:MS
Practice Address - Zip Code:38829-3498
Practice Address - Country:US
Practice Address - Phone:662-728-5732
Practice Address - Fax:662-728-5756
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-13
Last Update Date:2019-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy