Healthcare Provider Details

I. General information

NPI: 1104800440
Provider Name (Legal Business Name): SOUTHERN DISCOUNT DRUGS OF CHARLESTON INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/30/2005
Last Update Date: 07/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1068 FACTORY DR
CHARLESTON MS
38921-6620
US

IV. Provider business mailing address

1068 FACTORY DR
CHARLESTON MS
38921-6620
US

V. Phone/Fax

Practice location:
  • Phone: 662-647-6601
  • Fax: 662-647-2411
Mailing address:
  • Phone: 662-647-6601
  • Fax: 662-647-2411

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number1022
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number8226997-1714
License Number StateUT
# 3
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number056014
License Number StateAR
# 4
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License NumberDME18182
License Number StateID
# 5
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License NumberNPC-0003778
License Number StateOR
# 6
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License NumberMP00957
License Number StateNV
# 7
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License NumberP013728
License Number StateAZ
# 8
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number06473/11.1
License Number StateMS

VIII. Authorized Official

Name: MR. ROBERT SALMON
Title or Position: PHARMACIST
Credential: RPH
Phone: 662-647-2591