Provider Demographics
NPI:1982703716
Name:CROSSTOWN PHARMACY INC
Entity Type:Organization
Organization Name:CROSSTOWN PHARMACY INC
Other - Org Name:CROSSTOWN PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:
Authorized Official - Last Name:JAMES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:662-453-5615
Mailing Address - Street 1:111 W PARK AVE
Mailing Address - Street 2:STE C
Mailing Address - City:GREENWOOD
Mailing Address - State:MS
Mailing Address - Zip Code:38930-3006
Mailing Address - Country:US
Mailing Address - Phone:662-453-5615
Mailing Address - Fax:662-453-5616
Practice Address - Street 1:111 W PARK AVE
Practice Address - Street 2:STE C
Practice Address - City:GREENWOOD
Practice Address - State:MS
Practice Address - Zip Code:38930-3006
Practice Address - Country:US
Practice Address - Phone:662-453-5615
Practice Address - Fax:662-453-5616
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-21
Last Update Date:2010-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
MS00349/01.13336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2503642OtherNCPDP PROVIDER IDENTIFICATION NUMBER