Provider Demographics
NPI:1629242672
Name:CARTHAGE DISCOUNT DRUGS DME
Entity Type:Organization
Organization Name:CARTHAGE DISCOUNT DRUGS DME
Other - Org Name:CARTHAGE HEALTHMART PHAMRACY
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER/PHARMACIST
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFFERY
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:601-267-4581
Mailing Address - Street 1:602 HIGHWAY 16 E
Mailing Address - Street 2:
Mailing Address - City:CARTHAGE
Mailing Address - State:MS
Mailing Address - Zip Code:39051-4212
Mailing Address - Country:US
Mailing Address - Phone:601-267-4581
Mailing Address - Fax:601-267-3982
Practice Address - Street 1:602 HIGHWAY 16 E
Practice Address - Street 2:
Practice Address - City:CARTHAGE
Practice Address - State:MS
Practice Address - Zip Code:39051-4212
Practice Address - Country:US
Practice Address - Phone:601-267-4581
Practice Address - Fax:601-267-3982
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CARTHAGE DISCOUNT DRUG COMPANY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-04-21
Last Update Date:2008-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS00797/01.1333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS03927373Medicaid