Healthcare Provider Details

I. General information

NPI: 1235205154
Provider Name (Legal Business Name): ASHLAND DRUGS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/24/2006
Last Update Date: 03/09/2022
Certification Date: 02/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15917 BOUNDARY DRIVE
ASHLAND MS
38603
US

IV. Provider business mailing address

PO BOX 126
ASHLAND MS
38603
US

V. Phone/Fax

Practice location:
  • Phone: 662-224-8922
  • Fax: 662-224-9111
Mailing address:
  • Phone: 662-224-8922
  • Fax: 662-224-9111

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number01530
License Number StateMS

VIII. Authorized Official

Name: MR. LARRY H MELTON
Title or Position: OWNER PHARMACIST
Credential: RPH
Phone: 662-224-8922