Provider Demographics
NPI:1720084148
Name:JOHNS' DISCOUNT DRUGS, INC.
Entity Type:Organization
Organization Name:JOHNS' DISCOUNT DRUGS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:S
Authorized Official - Last Name:STEWART
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-794-6701
Mailing Address - Street 1:P. O. BOX 219
Mailing Address - Street 2:117 SHELBY SPEIGHTS DRIVE
Mailing Address - City:PURVIS
Mailing Address - State:MS
Mailing Address - Zip Code:39475-0219
Mailing Address - Country:US
Mailing Address - Phone:601-794-6701
Mailing Address - Fax:601-794-5550
Practice Address - Street 1:117 SHELBY SPEIGHTS DRIVE
Practice Address - Street 2:
Practice Address - City:PURVIS
Practice Address - State:MS
Practice Address - Zip Code:39475-0219
Practice Address - Country:US
Practice Address - Phone:601-794-6701
Practice Address - Fax:601-794-5550
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-21
Last Update Date:2022-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS00917333600000X, 3336L0003X
3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00037311Medicaid