Provider Demographics
NPI:1760880637
Name:TYSON DRUGS INC
Entity Type:Organization
Organization Name:TYSON DRUGS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:H
Authorized Official - Last Name:LOMENICK
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:662-252-2321
Mailing Address - Street 1:145 E VAN DORN AVE
Mailing Address - Street 2:
Mailing Address - City:HOLLY SPRINGS
Mailing Address - State:MS
Mailing Address - Zip Code:38635-3025
Mailing Address - Country:US
Mailing Address - Phone:662-252-2321
Mailing Address - Fax:662-252-1656
Practice Address - Street 1:145 E VAN DORN AVE
Practice Address - Street 2:
Practice Address - City:HOLLY SPRINGS
Practice Address - State:MS
Practice Address - Zip Code:38635-3025
Practice Address - Country:US
Practice Address - Phone:662-252-2321
Practice Address - Fax:662-252-1656
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-09
Last Update Date:2015-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSF05003336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MSF0500OtherPHARMACY
2590013OtherNCPDP