Provider Demographics
NPI:1952537029
Name:DUTCH PHARMACIES INC
Entity Type:Organization
Organization Name:DUTCH PHARMACIES INC
Other - Org Name:SOUTHERN LTC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PIC
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:GABLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:662-328-0833
Mailing Address - Street 1:103 12TH ST S
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:MS
Mailing Address - Zip Code:39701-5830
Mailing Address - Country:US
Mailing Address - Phone:662-328-0833
Mailing Address - Fax:
Practice Address - Street 1:103 12TH ST S
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:MS
Practice Address - Zip Code:39701-5830
Practice Address - Country:US
Practice Address - Phone:662-328-0833
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-03
Last Update Date:2017-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
MS08072/2.03336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2120322OtherPK