Provider Demographics
NPI:1881778330
Name:LAB DISCOUNT DRUGS, INC.
Entity type:Organization
Organization Name:LAB DISCOUNT DRUGS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:WARREN
Authorized Official - Middle Name:E
Authorized Official - Last Name:HUTTO
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:601-735-4444
Mailing Address - Street 1:923 WAYNE ST
Mailing Address - Street 2:
Mailing Address - City:WAYNESBORO
Mailing Address - State:MS
Mailing Address - Zip Code:39367-2571
Mailing Address - Country:US
Mailing Address - Phone:601-735-4444
Mailing Address - Fax:601-735-5885
Practice Address - Street 1:923 WAYNE ST
Practice Address - Street 2:
Practice Address - City:WAYNESBORO
Practice Address - State:MS
Practice Address - Zip Code:39367-2571
Practice Address - Country:US
Practice Address - Phone:601-735-4444
Practice Address - Fax:601-735-5885
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-24
Last Update Date:2012-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS01624/01.13336H0001X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL100230047Medicaid
MS00030358Medicaid
MS00030358Medicaid