Provider Demographics
NPI:1437261435
Name:DON WALDRONS MR DISCOUNT DRUGSTORE INC NO 1
Entity Type:Organization
Organization Name:DON WALDRONS MR DISCOUNT DRUGSTORE INC NO 1
Other - Org Name:MR DISCOUNT DRUGS #1
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DON
Authorized Official - Middle Name:L
Authorized Official - Last Name:WALDRON
Authorized Official - Suffix:SR
Authorized Official - Credentials:RPH
Authorized Official - Phone:601-693-1978
Mailing Address - Street 1:PO BOX 3790
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:MS
Mailing Address - Zip Code:39303-3790
Mailing Address - Country:US
Mailing Address - Phone:601-693-1978
Mailing Address - Fax:601-693-4417
Practice Address - Street 1:2205 14TH ST
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:MS
Practice Address - Zip Code:39301-4043
Practice Address - Country:US
Practice Address - Phone:601-693-1978
Practice Address - Fax:601-693-4417
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2020-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
MS01110/1.23336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00092801Medicaid
2043651OtherPK
1278990001Medicare NSC