Provider Demographics
NPI:1558404269
Name:MR DISCOUNT NO 2 OF MERIDIAN INC
Entity Type:Organization
Organization Name:MR DISCOUNT NO 2 OF MERIDIAN INC
Other - Org Name:MR DISCOUNT DRUGS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:RPH/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DON
Authorized Official - Middle Name:
Authorized Official - Last Name:WALDRON
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:601-483-3784
Mailing Address - Street 1:4832 POPLAR SPRINGS DR
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:MS
Mailing Address - Zip Code:39305-2624
Mailing Address - Country:US
Mailing Address - Phone:601-483-3784
Mailing Address - Fax:601-483-1659
Practice Address - Street 1:4832 POPLAR SPRINGS DR
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:MS
Practice Address - Zip Code:39305-2624
Practice Address - Country:US
Practice Address - Phone:601-483-3784
Practice Address - Fax:601-483-1659
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-14
Last Update Date:2018-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0004X, 3336L0003X
MS01338/1.23336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2044351OtherPK
MS00095214Medicaid