Healthcare Provider Details

I. General information

NPI: 1982796546
Provider Name (Legal Business Name): BYHALIA DRUG
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/29/2006
Last Update Date: 10/17/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2438 CHURCH ST
BYHALIA MS
38611
US

IV. Provider business mailing address

PO BOX 407
BYHALIA MS
38611
US

V. Phone/Fax

Practice location:
  • Phone: 662-838-2521
  • Fax: 662-838-4151
Mailing address:
  • Phone: 662-838-2521
  • Fax: 662-838-4151

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number01322011
License Number StateMS

VIII. Authorized Official

Name: MR. EDWARD HUGHES MCCULLOUGH JR.
Title or Position: PARTNER PHARMACIST
Credential: RPH
Phone: 662-838-2521