Provider Demographics
NPI:1689719833
Name:KINGS DISC DRUGS
Entity Type:Organization
Organization Name:KINGS DISC DRUGS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RPH
Authorized Official - Prefix:MR
Authorized Official - First Name:CHERIE
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:601-684-4344
Mailing Address - Street 1:1417 ASTON AVE
Mailing Address - Street 2:
Mailing Address - City:MCCOMB
Mailing Address - State:MS
Mailing Address - Zip Code:39648-2827
Mailing Address - Country:US
Mailing Address - Phone:601-684-4344
Mailing Address - Fax:601-684-5075
Practice Address - Street 1:1417 ASTON AVE
Practice Address - Street 2:
Practice Address - City:MCCOMB
Practice Address - State:MS
Practice Address - Zip Code:39648-2827
Practice Address - Country:US
Practice Address - Phone:601-684-4344
Practice Address - Fax:601-684-5075
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS01118011183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS0538640001Medicare UPIN
MN00092576Medicare ID - Type Unspecified