Provider Demographics
NPI:1912065434
Name:UNION DISCOUNT PHARMACY
Entity Type:Organization
Organization Name:UNION DISCOUNT PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBIN
Authorized Official - Middle Name:TIMOTHY
Authorized Official - Last Name:BAUER
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:601-774-2772
Mailing Address - Street 1:25025 HWY 15
Mailing Address - Street 2:
Mailing Address - City:UNION
Mailing Address - State:MS
Mailing Address - Zip Code:39365
Mailing Address - Country:US
Mailing Address - Phone:601-774-2772
Mailing Address - Fax:601-774-8779
Practice Address - Street 1:25025 HWY 15
Practice Address - Street 2:
Practice Address - City:UNION
Practice Address - State:MS
Practice Address - Zip Code:39365
Practice Address - Country:US
Practice Address - Phone:601-774-2772
Practice Address - Fax:601-774-8779
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-05
Last Update Date:2011-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS0542101.13336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS0330675Medicaid