Healthcare Provider Details

I. General information

NPI: 1871944827
Provider Name (Legal Business Name): BYHALIA DRUG COMPANY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/30/2016
Last Update Date: 05/23/2023
Certification Date: 05/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7984 HIGHWAY 178
BYHALIA MS
38611-6840
US

IV. Provider business mailing address

7984 HIGHWAY 178
BYHALIA MS
38611-6840
US

V. Phone/Fax

Practice location:
  • Phone: 662-838-3784
  • Fax: 662-838-3675
Mailing address:
  • Phone: 662-838-3784
  • Fax: 662-838-3675

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number14850/1.1
License Number StateMS
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: TONY SMITH
Title or Position: OWNER
Credential:
Phone: 662-728-1951