Provider Demographics
NPI:1760577589
Name:OKOLONA DRUG CO INC
Entity Type:Organization
Organization Name:OKOLONA DRUG CO INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHARMACIST
Authorized Official - Prefix:MR
Authorized Official - First Name:SIDNEY
Authorized Official - Middle Name:G
Authorized Official - Last Name:MORGAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:662-447-5471
Mailing Address - Street 1:210 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:OKOLONA
Mailing Address - State:MS
Mailing Address - Zip Code:38860-1425
Mailing Address - Country:US
Mailing Address - Phone:662-447-5471
Mailing Address - Fax:662-447-5637
Practice Address - Street 1:210 W MAIN ST
Practice Address - Street 2:
Practice Address - City:OKOLONA
Practice Address - State:MS
Practice Address - Zip Code:38860-1425
Practice Address - Country:US
Practice Address - Phone:662-447-5471
Practice Address - Fax:662-447-5637
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS00474011332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS0286290001Medicare ID - Type Unspecified