Provider Demographics
NPI:1598872863
Name:ROSE DRUG COMPANY
Entity Type:Organization
Organization Name:ROSE DRUG COMPANY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:MR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:W
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:662-494-3341
Mailing Address - Street 1:PO BOX 793
Mailing Address - Street 2:
Mailing Address - City:WEST POINT
Mailing Address - State:MS
Mailing Address - Zip Code:39773-0793
Mailing Address - Country:US
Mailing Address - Phone:662-494-3341
Mailing Address - Fax:662-494-3371
Practice Address - Street 1:137 COMMERCE ST
Practice Address - Street 2:
Practice Address - City:WEST POINT
Practice Address - State:MS
Practice Address - Zip Code:39773-2919
Practice Address - Country:US
Practice Address - Phone:662-494-3341
Practice Address - Fax:662-494-3371
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-24
Last Update Date:2008-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS00848/01.1MS332B00000X
MS00848/01.13336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00034045Medicaid
MS00045116Medicaid
MS00034045Medicaid