Provider Demographics
NPI:1821188475
Name:STANLEY DISCOUNT DRUGS, INC
Entity Type:Organization
Organization Name:STANLEY DISCOUNT DRUGS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:K
Authorized Official - Last Name:STANLEY
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:601-735-2513
Mailing Address - Street 1:804 SPRING ST
Mailing Address - Street 2:
Mailing Address - City:WAYNESBORO
Mailing Address - State:MS
Mailing Address - Zip Code:39367-2422
Mailing Address - Country:US
Mailing Address - Phone:601-735-2513
Mailing Address - Fax:601-735-1333
Practice Address - Street 1:804 SPRING ST
Practice Address - Street 2:
Practice Address - City:WAYNESBORO
Practice Address - State:MS
Practice Address - Zip Code:39367-2422
Practice Address - Country:US
Practice Address - Phone:601-735-2513
Practice Address - Fax:601-735-1333
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-13
Last Update Date:2007-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00030443Medicaid
2507777OtherNCPDP
MS07573840Medicaid
0700250001Medicare ID - Type Unspecified