Healthcare Provider Details

I. General information

NPI: 1093884025
Provider Name (Legal Business Name): SOUTHERN DISCOUNT DRUGS OF CHARLESTON INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/06/2006
Last Update Date: 08/17/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

109 W WALNUT ST
CHARLESTON MS
38921-2242
US

IV. Provider business mailing address

109 W WALNUT ST
CHARLESTON MS
38921-2242
US

V. Phone/Fax

Practice location:
  • Phone: 662-647-5172
  • Fax:
Mailing address:
  • Phone: 662-647-5172
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberE05166
License Number StateMS

VIII. Authorized Official

Name: MR. ROBERT L SALMON
Title or Position: PHARMACIST
Credential: R.PH.
Phone: 662-647-5172