Provider Demographics
NPI:1457441941
Name:POWELL DRUGS LLC
Entity Type:Organization
Organization Name:POWELL DRUGS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHARMACIST
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:HOMER
Authorized Official - Last Name:POWELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-797-3355
Mailing Address - Street 1:P. O. BOX 249
Mailing Address - Street 2:
Mailing Address - City:MT. OLIVE
Mailing Address - State:MS
Mailing Address - Zip Code:39119
Mailing Address - Country:US
Mailing Address - Phone:601-797-3881
Mailing Address - Fax:601-797-4624
Practice Address - Street 1:519 MAIN ST
Practice Address - Street 2:
Practice Address - City:MT. OLIVE
Practice Address - State:MS
Practice Address - Zip Code:39119
Practice Address - Country:US
Practice Address - Phone:601-797-3881
Practice Address - Fax:601-797-4624
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-13
Last Update Date:2022-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00033758Medicaid