Provider Demographics
NPI:1801960323
Name:MR DISCOUNT NO 2 OF MERIDIAN INC
Entity type:Organization
Organization Name:MR DISCOUNT NO 2 OF MERIDIAN INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHARM MGR
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:NEAL
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:601-482-5578
Mailing Address - Street 1:4420 8TH ST
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:MS
Mailing Address - Zip Code:39307-5954
Mailing Address - Country:US
Mailing Address - Phone:601-482-5578
Mailing Address - Fax:601-483-1123
Practice Address - Street 1:4420 8TH ST
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:MS
Practice Address - Zip Code:39307-5954
Practice Address - Country:US
Practice Address - Phone:601-482-5578
Practice Address - Fax:601-483-1123
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-17
Last Update Date:2018-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
MS01423/1.13336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2044453OtherPK
MS00030081Medicaid
MS00030081Medicaid