Healthcare Provider Details

I. General information

NPI: 1346336757
Provider Name (Legal Business Name): GRIFFIN'S DISCOUNT PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

339 E MADISON ST
HOUSTON MS
38851-2322
US

IV. Provider business mailing address

339 E MADISON ST
HOUSTON MS
38851-2322
US

V. Phone/Fax

Practice location:
  • Phone: 662-456-2501
  • Fax: 662-456-4052
Mailing address:
  • Phone: 662-456-2501
  • Fax: 662-456-4052

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number01477
License Number StateMS

VIII. Authorized Official

Name: MR. KEN R FULLILOVE JR.
Title or Position: CO-OWNER
Credential:
Phone: 662-456-2501