Provider Demographics
NPI:1740404805
Name:HAMMACK DRUGS, LLC
Entity Type:Organization
Organization Name:HAMMACK DRUGS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KIM
Authorized Official - Middle Name:D
Authorized Official - Last Name:CHANCELLOR
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:601-776-3711
Mailing Address - Street 1:101 A WEST DONALD STREET
Mailing Address - Street 2:
Mailing Address - City:QUITMAN
Mailing Address - State:MS
Mailing Address - Zip Code:39355
Mailing Address - Country:US
Mailing Address - Phone:601-776-3711
Mailing Address - Fax:601-776-6311
Practice Address - Street 1:101 W DONALD ST
Practice Address - Street 2:
Practice Address - City:QUITMAN
Practice Address - State:MS
Practice Address - Zip Code:39355-2013
Practice Address - Country:US
Practice Address - Phone:601-776-3711
Practice Address - Fax:601-776-6311
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-12
Last Update Date:2017-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSE7339183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00330540Medicaid