Provider Demographics
NPI:1568787968
Name:KING'S DISCOUNT PHARMACY
Entity Type:Organization
Organization Name:KING'S DISCOUNT PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:G
Authorized Official - Last Name:KING
Authorized Official - Suffix:JR
Authorized Official - Credentials:BS
Authorized Official - Phone:601-384-2898
Mailing Address - Street 1:PO BOX 134
Mailing Address - Street 2:
Mailing Address - City:BUDE
Mailing Address - State:MS
Mailing Address - Zip Code:39630-0134
Mailing Address - Country:US
Mailing Address - Phone:601-384-2898
Mailing Address - Fax:601-384-4326
Practice Address - Street 1:44 HWY 98 EAST
Practice Address - Street 2:
Practice Address - City:BUDE
Practice Address - State:MS
Practice Address - Zip Code:39630
Practice Address - Country:US
Practice Address - Phone:601-384-2898
Practice Address - Fax:601-384-4326
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-30
Last Update Date:2010-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00440920Medicaid