Provider Demographics
NPI:1851471155
Name:DELTA DISCOUNT DRUGS INC.
Entity Type:Organization
Organization Name:DELTA DISCOUNT DRUGS INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENTAL PHARMACIST
Authorized Official - Prefix:MR
Authorized Official - First Name:MARVIN
Authorized Official - Middle Name:CAREY
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:662-624-5190
Mailing Address - Street 1:731 S STATE ST
Mailing Address - Street 2:
Mailing Address - City:CLARKSDALE
Mailing Address - State:MS
Mailing Address - Zip Code:38614-4801
Mailing Address - Country:US
Mailing Address - Phone:662-624-5190
Mailing Address - Fax:
Practice Address - Street 1:731 S STATE ST
Practice Address - Street 2:
Practice Address - City:CLARKSDALE
Practice Address - State:MS
Practice Address - Zip Code:38614-4801
Practice Address - Country:US
Practice Address - Phone:662-624-5190
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS02059/01.1183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS0030596Medicaid