Healthcare Provider Details

I. General information

NPI: 1437164076
Provider Name (Legal Business Name): BANE DRUGS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/30/2006
Last Update Date: 06/18/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

360 W MONTICELLO ST
BROOKHAVEN MS
39601-3206
US

IV. Provider business mailing address

360 W MONTICELLO ST
BROOKHAVEN MS
39601-3206
US

V. Phone/Fax

Practice location:
  • Phone: 601-833-1922
  • Fax: 601-833-0245
Mailing address:
  • Phone: 601-833-1922
  • Fax: 601-833-0245

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number00402011
License Number StateMS

VIII. Authorized Official

Name: BEVERLY CASE
Title or Position: PHARMACIST
Credential:
Phone: 601-833-1922