Healthcare Provider Details

I. General information

NPI: 1972648236
Provider Name (Legal Business Name): RUSSELL'S MR DISCOUNT DRUGS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/21/2007
Last Update Date: 11/10/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

334 DEPOT ST
LEXINGTON MS
39095-3607
US

IV. Provider business mailing address

334 DEPOT ST
LEXINGTON MS
39095-3607
US

V. Phone/Fax

Practice location:
  • Phone: 662-834-0666
  • Fax: 662-834-0681
Mailing address:
  • Phone: 662-834-0666
  • Fax: 662-834-0681

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License NumberR06886
License Number StateMS

VIII. Authorized Official

Name: MR. WILLIAM BRUCE RUSSELL
Title or Position: OWNER PHARMACIST
Credential: RPH
Phone: 662-834-1154