MEDICARE: POLKS CROSSGATES DISCOUNT DRUGS INC

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	183500000X	Pharmacist	02279	MS
2	332B00000X	Durable Medical Equipment & Medical Supplies
3	3336C0003X	Community/Retail Pharmacy

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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1932138872
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	POLKS CROSSGATES DISCOUNT DRUGS INC

Provider Business Mailing Address
First Line	:	1866 SPILLWAY RD
Second Line	:
City	:	BRANDON
State	:	MS
Zip	:	39047-6063
Country	:	US
Telephone Number	:	601-992-4466
Fax Number	:	601-992-4415

Provider Business Practice Location Address
First Line	:	1866 SPILLWAY RD
Second Line	:
City	:	BRANDON
State	:	MS
Zip	:	39047-6063
Country	:	US
Telephone Number	:	601-992-4466
Fax Number	:	601-992-4415

Authorized Official
Title or Position	:	MANGER
Name	:	MR. ANDREW L HUBBARD
Credential	:
Telephone Number	:	601-992-4450

Provider Enumeration Date	:	07/02/2006
Last Update Date	:	03/19/2025

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