Provider Demographics
NPI:1609911429
Name:SHEPARD DISCOUNT DRUGS
Entity Type:Organization
Organization Name:SHEPARD DISCOUNT DRUGS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JACK
Authorized Official - Middle Name:AUSTIN
Authorized Official - Last Name:SHEPARD
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:601-736-8211
Mailing Address - Street 1:PO BOX 148
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MS
Mailing Address - Zip Code:39429-0148
Mailing Address - Country:US
Mailing Address - Phone:601-736-8211
Mailing Address - Fax:601-736-3415
Practice Address - Street 1:431 BROAD ST
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MS
Practice Address - Zip Code:39429-3038
Practice Address - Country:US
Practice Address - Phone:601-736-8211
Practice Address - Fax:601-736-3415
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00330460Medicaid