Provider Demographics
NPI:1629241542
Name:DOWNTOWN DRUG LLC
Entity Type:Organization
Organization Name:DOWNTOWN DRUG LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST/MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:WARREN
Authorized Official - Last Name:HOLLINGSWORTH
Authorized Official - Suffix:
Authorized Official - Credentials:PD
Authorized Official - Phone:601-225-7333
Mailing Address - Street 1:PO BOX 974
Mailing Address - Street 2:
Mailing Address - City:GLOSTER
Mailing Address - State:MS
Mailing Address - Zip Code:39638-0974
Mailing Address - Country:US
Mailing Address - Phone:601-225-7333
Mailing Address - Fax:601-225-7332
Practice Address - Street 1:129 MAIN STREET
Practice Address - Street 2:
Practice Address - City:GLOSTER
Practice Address - State:MS
Practice Address - Zip Code:39638
Practice Address - Country:US
Practice Address - Phone:601-225-7333
Practice Address - Fax:601-225-7332
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-11
Last Update Date:2008-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS077073336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS07707OtherBOARD OF PHARMACY