Provider Demographics
NPI:1700839552
Name:PEARSON DISCOUNT DRUGS
Entity Type:Organization
Organization Name:PEARSON DISCOUNT DRUGS
Other - Org Name:HOMETOWN HEALTHCARE
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:S
Authorized Official - Last Name:KILGORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:662-456-4630
Mailing Address - Street 1:1113 HIGHWAY 278 E
Mailing Address - Street 2:
Mailing Address - City:AMORY
Mailing Address - State:MS
Mailing Address - Zip Code:38821-5627
Mailing Address - Country:US
Mailing Address - Phone:662-256-2955
Mailing Address - Fax:662-256-2944
Practice Address - Street 1:1113 HIGHWAY 278 E
Practice Address - Street 2:
Practice Address - City:AMORY
Practice Address - State:MS
Practice Address - Zip Code:38821-5627
Practice Address - Country:US
Practice Address - Phone:662-256-2955
Practice Address - Fax:662-256-2944
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-19
Last Update Date:2024-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS06731/02.0332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00045092Medicaid
MS0286220001Medicare NSC