Healthcare Provider Details

I. General information

NPI: 1215344460
Provider Name (Legal Business Name): ASHLAND DRUG STORE, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/21/2014
Last Update Date: 07/21/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15917 BOUNDARY DRIVE
ASHLAND MS
38603
US

IV. Provider business mailing address

15917 BOUNDARY DR
ASHLAND MS
38603
US

V. Phone/Fax

Practice location:
  • Phone: 662-224-8922
  • Fax:
Mailing address:
  • Phone: 662-224-8922
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State

VIII. Authorized Official

Name: DR. BAILEY MELTON
Title or Position: PHARMD
Credential:
Phone: 662-224-8922