Provider Demographics
NPI:1184745630
Name:ATTALA DISCOUNT DRUGS
Entity type:Organization
Organization Name:ATTALA DISCOUNT DRUGS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:VICKIE
Authorized Official - Middle Name:
Authorized Official - Last Name:ELLINGTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:662-289-2312
Mailing Address - Street 1:PO BOX 691
Mailing Address - Street 2:
Mailing Address - City:KOSCIUSKO
Mailing Address - State:MS
Mailing Address - Zip Code:39090-0691
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:337 HIGHWAY 12 W
Practice Address - Street 2:
Practice Address - City:KOSCIUSKO
Practice Address - State:MS
Practice Address - Zip Code:39090-3255
Practice Address - Country:US
Practice Address - Phone:662-289-2312
Practice Address - Fax:662-289-2317
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-03
Last Update Date:2008-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSE67373336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2508616OtherOTHER ID NUMBER COMMERCIAL NUMBER
2508616OtherOTHER ID NUMBER