Provider Demographics
NPI:1376798926
Name:RXS OKOLONA LLC
Entity Type:Organization
Organization Name:RXS OKOLONA LLC
Other - Org Name:SUPER SAV-ON-DRUGS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BEAU
Authorized Official - Middle Name:
Authorized Official - Last Name:COX
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:662-447-5400
Mailing Address - Street 1:203 S CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:OKOLONA
Mailing Address - State:MS
Mailing Address - Zip Code:38860-1608
Mailing Address - Country:US
Mailing Address - Phone:662-447-5400
Mailing Address - Fax:
Practice Address - Street 1:203 S CHURCH ST
Practice Address - Street 2:
Practice Address - City:OKOLONA
Practice Address - State:MS
Practice Address - Zip Code:38860-1608
Practice Address - Country:US
Practice Address - Phone:662-447-5400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-24
Last Update Date:2010-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS07975/01.13336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2587535OtherNCPDP PROVIDER IDENTIFICATION NUMBER