Provider Demographics
NPI:1437201704
Name:BOYD'S DRUG STORE,INC
Entity Type:Organization
Organization Name:BOYD'S DRUG STORE,INC
Other - Org Name:BOYD'S DRUG STORE,INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:AMZIE
Authorized Official - Last Name:BOYD
Authorized Official - Suffix:JR
Authorized Official - Credentials:BS PHARMACY
Authorized Official - Phone:662-289-2211
Mailing Address - Street 1:101 W JEFFERSON ST
Mailing Address - Street 2:BOX 662
Mailing Address - City:KOSCIUSKO
Mailing Address - State:MS
Mailing Address - Zip Code:39090-3618
Mailing Address - Country:US
Mailing Address - Phone:662-289-2211
Mailing Address - Fax:662-289-6973
Practice Address - Street 1:101 W JEFFERSON ST
Practice Address - Street 2:BOX 662
Practice Address - City:KOSCIUSKO
Practice Address - State:MS
Practice Address - Zip Code:39090-3618
Practice Address - Country:US
Practice Address - Phone:662-289-2211
Practice Address - Fax:662-289-6973
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSE3663183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS0030490Medicaid