Healthcare Provider Details

I. General information

NPI: 1366583205
Provider Name (Legal Business Name): SOUTHERN DISCOUNT DRUGS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/12/2007
Last Update Date: 01/24/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 N MAIN ST
CALHOUN CITY MS
38916-9677
US

IV. Provider business mailing address

1101 N MAIN ST
CALHOUN CITY MS
38916-9677
US

V. Phone/Fax

Practice location:
  • Phone: 662-628-5000
  • Fax: 662-628-1555
Mailing address:
  • Phone: 662-628-5000
  • Fax: 662-628-1555

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberE7662
License Number StateMS

VIII. Authorized Official

Name: MICHAEL TODD COSPELICH
Title or Position: PHARMACIST MANAGER
Credential: R.PH.
Phone: 662-628-5000