Provider Demographics
NPI:1699817361
Name:SOUTHWEST DISCOUN T DRUGS
Entity Type:Organization
Organization Name:SOUTHWEST DISCOUN T DRUGS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOE
Authorized Official - Middle Name:KEITH
Authorized Official - Last Name:GUY
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:601-684-4541
Mailing Address - Street 1:1220 LASALLE ST
Mailing Address - Street 2:
Mailing Address - City:MCCOMB
Mailing Address - State:MS
Mailing Address - Zip Code:39648-5158
Mailing Address - Country:US
Mailing Address - Phone:601-684-4541
Mailing Address - Fax:601-684-4003
Practice Address - Street 1:1220 LASALLE ST
Practice Address - Street 2:
Practice Address - City:MCCOMB
Practice Address - State:MS
Practice Address - Zip Code:39648-5158
Practice Address - Country:US
Practice Address - Phone:601-684-4541
Practice Address - Fax:601-684-4003
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-12
Last Update Date:2021-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS01536101333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00030179Medicaid