Provider Demographics
NPI:1891820098
Name:STANDARD MARKETING INC
Entity Type:Organization
Organization Name:STANDARD MARKETING INC
Other - Org Name:STANDARD DRUG STORE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:PHILLIPS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-764-2862
Mailing Address - Street 1:PO BOX 870
Mailing Address - Street 2:
Mailing Address - City:BAY SPRINGS
Mailing Address - State:MS
Mailing Address - Zip Code:39422-0870
Mailing Address - Country:US
Mailing Address - Phone:601-764-2862
Mailing Address - Fax:601-764-3379
Practice Address - Street 1:32 S SIXTH ST
Practice Address - Street 2:
Practice Address - City:BAY SPRINGS
Practice Address - State:MS
Practice Address - Zip Code:39422-9055
Practice Address - Country:US
Practice Address - Phone:601-764-2862
Practice Address - Fax:601-764-3379
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-21
Last Update Date:2016-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
MS00313/1.13336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00030653Medicaid
2044981OtherPK