Provider Demographics
NPI:1780749739
Name:TUNICA QUALITY DRUGS, INC
Entity type:Organization
Organization Name:TUNICA QUALITY DRUGS, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DWIGHT
Authorized Official - Middle Name:
Authorized Official - Last Name:SOREY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:662-363-1540
Mailing Address - Street 1:PO BOX 1229
Mailing Address - Street 2:
Mailing Address - City:TUNICA
Mailing Address - State:MS
Mailing Address - Zip Code:38676-1229
Mailing Address - Country:US
Mailing Address - Phone:662-363-1540
Mailing Address - Fax:662-363-6706
Practice Address - Street 1:1068 HIGHWAY 61 N
Practice Address - Street 2:
Practice Address - City:TUNICA
Practice Address - State:MS
Practice Address - Zip Code:38676
Practice Address - Country:US
Practice Address - Phone:662-363-1540
Practice Address - Fax:662-363-6706
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-27
Last Update Date:2014-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336L0003X
MS011410113336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2044319OtherPK
MS0034721Medicaid