Provider Demographics
NPI:1497541775
Name:STATE LINE DRUGS
Entity type:Organization
Organization Name:STATE LINE DRUGS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:SNYDER
Authorized Official - Suffix:
Authorized Official - Credentials:R,PH
Authorized Official - Phone:601-394-8264
Mailing Address - Street 1:PO BOX 159
Mailing Address - Street 2:
Mailing Address - City:STATE LINE
Mailing Address - State:MS
Mailing Address - Zip Code:39362-0159
Mailing Address - Country:US
Mailing Address - Phone:601-848-7866
Mailing Address - Fax:601-848-7346
Practice Address - Street 1:194 MAIN ST
Practice Address - Street 2:
Practice Address - City:STATE LINE
Practice Address - State:MS
Practice Address - Zip Code:39362-9600
Practice Address - Country:US
Practice Address - Phone:601-848-7866
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-04-15
Last Update Date:2025-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy