Healthcare Provider Details

I. General information

NPI: 1811001878
Provider Name (Legal Business Name): COLLINSVILLE DRUGS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/18/2006
Last Update Date: 07/14/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9158 HWY 19
COLLINSVILLE MS
39325-0175
US

IV. Provider business mailing address

PO BOX 175
COLLINSVILLE MS
39325-0175
US

V. Phone/Fax

Practice location:
  • Phone: 601-626-8242
  • Fax: 601-626-8082
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number1587/ 1.1
License Number StateMS

VIII. Authorized Official

Name: DONNIE SCRIVNER
Title or Position: OWNER
Credential: RPH
Phone: 601-626-8242