Healthcare Provider Details

I. General information

NPI: 1528079035
Provider Name (Legal Business Name): KINGS DISCOUNT PHARMACY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/10/2006
Last Update Date: 09/20/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44 HWY 98 E
BUDE MS
39630-0134
US

IV. Provider business mailing address

PO BOX 134
BUDE MS
39630-0134
US

V. Phone/Fax

Practice location:
  • Phone: 601-384-2898
  • Fax: 601-384-4326
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number01357
License Number StateMS

VIII. Authorized Official

Name: RICHARD KING
Title or Position: OWNER
Credential: RPH
Phone: 601-384-2898