Provider Demographics
NPI:1417236894
Name:MISSISSIPPI DISCOUNT DRUGS LLC
Entity Type:Organization
Organization Name:MISSISSIPPI DISCOUNT DRUGS LLC
Other - Org Name:MISSISSIPPI DISCOUNT DRUGS #2
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:C
Authorized Official - Last Name:MURPHY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-859-3939
Mailing Address - Street 1:195 E PEACE ST
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MS
Mailing Address - Zip Code:39046-4519
Mailing Address - Country:US
Mailing Address - Phone:601-859-3939
Mailing Address - Fax:601-855-2133
Practice Address - Street 1:276 NISSAN PKWY STE 300
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:MS
Practice Address - Zip Code:39046-7006
Practice Address - Country:US
Practice Address - Phone:601-855-7330
Practice Address - Fax:601-855-7332
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-16
Last Update Date:2011-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336L0003X
MS09091/1.13336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2588397OtherNCPDP PROVIDER IDENTIFICATION NUMBER