Provider Demographics
NPI:1417507237
Name:MISSISSIPPI DISCOUNT DRUGS LLC
Entity Type:Organization
Organization Name:MISSISSIPPI DISCOUNT DRUGS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:CARL
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:
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?:Yes
Parent Organization LBN:MISSISSIPPI DISCOUNT DRUGS LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-09-13
Last Update Date:2019-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy