Healthcare Provider Details

I. General information

NPI: 1730186982
Provider Name (Legal Business Name): MISSISSIPPI DISCOUNT DRUGS OF CLINTON INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/02/2005
Last Update Date: 08/02/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

224 CLINTON BLVD
CLINTON MS
39056-5126
US

IV. Provider business mailing address

224 CLINTON BLVD
CLINTON MS
39056-5126
US

V. Phone/Fax

Practice location:
  • Phone: 601-924-5212
  • Fax: 601-924-4649
Mailing address:
  • Phone: 601-924-5212
  • Fax: 601-924-4649

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number00837/01.1
License Number StateMS

VIII. Authorized Official

Name: CARY PARKS
Title or Position: GENERAL MGR AND OWNER
Credential: ACCOUNTING
Phone: 601-924-5212