Provider Demographics
NPI:1982796546
Name:BYHALIA DRUG
Entity Type:Organization
Organization Name:BYHALIA DRUG
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER PHARMACIST
Authorized Official - Prefix:MR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:HUGHES
Authorized Official - Last Name:MCCULLOUGH
Authorized Official - Suffix:JR
Authorized Official - Credentials:RPH
Authorized Official - Phone:662-838-2521
Mailing Address - Street 1:PO BOX 407
Mailing Address - Street 2:
Mailing Address - City:BYHALIA
Mailing Address - State:MS
Mailing Address - Zip Code:38611
Mailing Address - Country:US
Mailing Address - Phone:662-838-2521
Mailing Address - Fax:662-838-4151
Practice Address - Street 1:2438 CHURCH ST
Practice Address - Street 2:
Practice Address - City:BYHALIA
Practice Address - State:MS
Practice Address - Zip Code:38611
Practice Address - Country:US
Practice Address - Phone:662-838-2521
Practice Address - Fax:662-838-4151
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-29
Last Update Date:2007-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS01322011333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00094862Medicaid