Provider Demographics
NPI:1952411332
Name:PEOPLES DRUG STORE LEXINGTON INC
Entity Type:Organization
Organization Name:PEOPLES DRUG STORE LEXINGTON INC
Other - Org Name:PEOPLES DRUG STORE
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:GUY
Authorized Official - Middle Name:M
Authorized Official - Last Name:PHILLIPS
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:662-834-2722
Mailing Address - Street 1:102 COURT SQ
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:MS
Mailing Address - Zip Code:39095-3626
Mailing Address - Country:US
Mailing Address - Phone:662-834-2722
Mailing Address - Fax:662-834-1711
Practice Address - Street 1:102 COURT SQ
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:MS
Practice Address - Zip Code:39095-3626
Practice Address - Country:US
Practice Address - Phone:662-834-2722
Practice Address - Fax:662-834-1711
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2023-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS00350-01.13336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00030271Medicaid
MS2505177OtherNABP NUMBER