Healthcare Provider Details

I. General information

NPI: 1144427444
Provider Name (Legal Business Name): HARRISVILLE DISCOUNT DRUGS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/29/2007
Last Update Date: 07/12/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1598 SIMPSON HWY. 469
HARRISVILLE MS
39082
US

IV. Provider business mailing address

1598 SIMPSON HWY. 469
HARRISVILLE MS
39082
US

V. Phone/Fax

Practice location:
  • Phone: 601-847-7914
  • Fax:
Mailing address:
  • Phone: 601-847-7914
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number07381
License Number StateMS

VIII. Authorized Official

Name: DR. THOMAS EDWARD SPELL JR.
Title or Position: OWNER
Credential:
Phone: 601-847-7914