Healthcare Provider Details

I. General information

NPI: 1538717459
Provider Name (Legal Business Name): SQUARE DRUGS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/04/2019
Last Update Date: 03/25/2022
Certification Date: 03/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

126 COURT SQUARE
CHARLESTON MS
38921
US

IV. Provider business mailing address

126 COURT SQUARE
CHARLESTON MS
38921
US

V. Phone/Fax

Practice location:
  • Phone: 662-783-6100
  • Fax: 662-783-3007
Mailing address:
  • Phone: 662-783-6100
  • Fax: 662-783-3007

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: ANGELA BAILEY ROWSEY
Title or Position: OWNER
Credential:
Phone: 662-783-6100