Provider Demographics
NPI:1740412964
Name:BATTLEFIELD EXPRESS DRUGS INCORPORATED
Entity Type:Organization
Organization Name:BATTLEFIELD EXPRESS DRUGS INCORPORATED
Other - Org Name:BATTLEFIELD EXPRESS DRUGS
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:STOREY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-642-7050
Mailing Address - Street 1:120 STENSON RD
Mailing Address - Street 2:
Mailing Address - City:VICKSBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39180-8860
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2080 S FRONTAGE RD
Practice Address - Street 2:SUITE 101
Practice Address - City:VICKSBURG
Practice Address - State:MS
Practice Address - Zip Code:39180-5328
Practice Address - Country:US
Practice Address - Phone:601-619-1550
Practice Address - Fax:601-638-8446
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-21
Last Update Date:2009-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS08209/01.13336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2587763OtherNCPDP PROVIDER IDENTIFICATION NUMBER