Provider Demographics
NPI:1720009772
Name:CITY REXALL DRUGS INC
Entity Type:Organization
Organization Name:CITY REXALL DRUGS INC
Other - Org Name:CITY REXALL DRUGS INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:GRIFFIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-798-4761
Mailing Address - Street 1:349 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:PICAYUNE
Mailing Address - State:MS
Mailing Address - Zip Code:39466-4415
Mailing Address - Country:US
Mailing Address - Phone:601-798-4761
Mailing Address - Fax:601-798-4761
Practice Address - Street 1:349 S MAIN ST
Practice Address - Street 2:
Practice Address - City:PICAYUNE
Practice Address - State:MS
Practice Address - Zip Code:39466-4415
Practice Address - Country:US
Practice Address - Phone:601-798-4761
Practice Address - Fax:601-798-4761
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-22
Last Update Date:2015-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS00179/1.13336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2043348OtherPK
MS00045063Medicaid
0556690001Medicare NSC