Provider Demographics
NPI:1134212574
Name:READ DISCOUNT DRUG
Entity type:Organization
Organization Name:READ DISCOUNT DRUG
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:READ
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:601-426-3238
Mailing Address - Street 1:PO BOX 8111
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MS
Mailing Address - Zip Code:39441-8111
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1592 HIGHWAY 15 N STE D
Practice Address - Street 2:STE D
Practice Address - City:LAUREL
Practice Address - State:MS
Practice Address - Zip Code:39440-2122
Practice Address - Country:US
Practice Address - Phone:601-426-3238
Practice Address - Fax:601-425-1374
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-30
Last Update Date:2016-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
MS00722/ 1.13336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2050465OtherPK
MS0033928Medicaid