Provider Demographics
NPI:1205175031
Name:PICAYUNE DRUG CO. NORTH
Entity type:Organization
Organization Name:PICAYUNE DRUG CO. NORTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:L
Authorized Official - Last Name:FAILLA
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:601-273-0042
Mailing Address - Street 1:3310 HIGHWAY 11 N
Mailing Address - Street 2:
Mailing Address - City:PICAYUNE
Mailing Address - State:MS
Mailing Address - Zip Code:39466-2000
Mailing Address - Country:US
Mailing Address - Phone:601-798-4846
Mailing Address - Fax:601-798-4825
Practice Address - Street 1:3310 HIGHWAY 11 N
Practice Address - Street 2:
Practice Address - City:PICAYUNE
Practice Address - State:MS
Practice Address - Zip Code:39466-2000
Practice Address - Country:US
Practice Address - Phone:601-798-4846
Practice Address - Fax:601-798-4825
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-14
Last Update Date:2013-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy