Healthcare Provider Details

I. General information

NPI: 1699782003
Provider Name (Legal Business Name): CLAYTON DRUG STORE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/01/2006
Last Update Date: 10/28/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

216 MAIN ST
COLLINS MS
39428
US

IV. Provider business mailing address

PO BOX 787
COLLINS MS
39428-0787
US

V. Phone/Fax

Practice location:
  • Phone: 601-765-4323
  • Fax: 601-765-4962
Mailing address:
  • Phone: 601-765-4323
  • Fax: 601-765-4962

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number00553/01.1
License Number StateMS

VIII. Authorized Official

Name: RICK A CHAMBERS
Title or Position: PRESIDENT
Credential: PHARM.D.
Phone: 901-481-1511