MEDICARE: BIGGS DRUGSTORE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies
2	333600000X	Pharmacy	00613/01.1	MS

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1063472793
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BIGGS DRUGSTORE

Provider Business Mailing Address
First Line	:	101 E GEORGETOWN ST
Second Line	:
City	:	CRYSTAL SPRINGS
State	:	MS
Zip	:	39059-2777
Country	:	US
Telephone Number	:	601-892-4061
Fax Number	:	601-892-6055

Provider Business Practice Location Address
First Line	:	101 E GEORGETOWN ST
Second Line	:
City	:	CRYSTAL SPRINGS
State	:	MS
Zip	:	39059-2777
Country	:	US
Telephone Number	:	601-892-4061
Fax Number	:	601-892-6055

Authorized Official
Title or Position	:	OWNER/PHARMACIST
Name	:	MR. THOMAS EDWARD SPELL JR.
Credential	:	R.PH.
Telephone Number	:	601-892-4061

Provider Enumeration Date	:	03/25/2006
Last Update Date	:	04/24/2008

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Directions to “BIGGS DRUGSTORE ” Practice Location

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