Provider Demographics
NPI:1205991528
Name:TRI - X DRUGS INC
Entity type:Organization
Organization Name:TRI - X DRUGS INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VP
Authorized Official - Prefix:
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:
Authorized Official - Last Name:WOZENCRAFT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-784-3313
Mailing Address - Street 1:PO BOX 677
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:MS
Mailing Address - Zip Code:39423-0677
Mailing Address - Country:US
Mailing Address - Phone:601-784-3313
Mailing Address - Fax:601-784-3310
Practice Address - Street 1:881 HIGHWAY 198
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:MS
Practice Address - Zip Code:39423-2070
Practice Address - Country:US
Practice Address - Phone:601-784-3313
Practice Address - Fax:601-784-3310
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-27
Last Update Date:2014-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS01718/1.13336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2050610OtherPK
MS00030261Medicaid