Provider Demographics
NPI:1710622865
Name:DIKET'S PROFESSIONAL DRUGS
Entity Type:Organization
Organization Name:DIKET'S PROFESSIONAL DRUGS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOE
Authorized Official - Middle Name:
Authorized Official - Last Name:ROBERTSON
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:601-498-4332
Mailing Address - Street 1:PO BOX 446
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MS
Mailing Address - Zip Code:39441-0446
Mailing Address - Country:US
Mailing Address - Phone:601-428-4334
Mailing Address - Fax:
Practice Address - Street 1:1107 JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MS
Practice Address - Zip Code:39440-4352
Practice Address - Country:US
Practice Address - Phone:601-428-4334
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WALLACE DRUG COMPANY INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-05-03
Last Update Date:2022-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy