Provider Demographics
NPI:1952049454
Name:PEARSONS DISCOUNT DRUGS LLC
Entity Type:Organization
Organization Name:PEARSONS DISCOUNT DRUGS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WALTER
Authorized Official - Middle Name:STEPHEN
Authorized Official - Last Name:PEARSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:662-456-2551
Mailing Address - Street 1:PO BOX 509
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:MS
Mailing Address - Zip Code:38851-0509
Mailing Address - Country:US
Mailing Address - Phone:662-456-2551
Mailing Address - Fax:
Practice Address - Street 1:101 E WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:MS
Practice Address - Zip Code:38851-2225
Practice Address - Country:US
Practice Address - Phone:662-456-2551
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-24
Last Update Date:2022-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00034747Medicaid