Provider Demographics
NPI:1598916801
Name:DUTCH PHARMACIES INC
Entity Type:Organization
Organization Name:DUTCH PHARMACIES INC
Other - Org Name:SOUTHERN DRUGS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PIC
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:GABLE
Authorized Official - Suffix:
Authorized Official - Credentials:BS PHARMACIST
Authorized Official - Phone:662-328-0833
Mailing Address - Street 1:1202 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:MS
Mailing Address - Zip Code:39701-5833
Mailing Address - Country:US
Mailing Address - Phone:662-328-0833
Mailing Address - Fax:662-328-6633
Practice Address - Street 1:1202 MAIN ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:MS
Practice Address - Zip Code:39701-5833
Practice Address - Country:US
Practice Address - Phone:662-328-0833
Practice Address - Fax:662-328-6633
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-06
Last Update Date:2017-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0004X
MS00325/2.23336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00030055Medicaid
2117266OtherPK
MS4371030003Medicare NSC