Healthcare Provider Details

I. General information

NPI: 1639135908
Provider Name (Legal Business Name): RUSSELLS MR DISCOUNT DRUGS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/25/2006
Last Update Date: 12/08/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

334 DEPOT STREET
LEXINGTON MS
39095-3607
US

IV. Provider business mailing address

334 DEPOT STREET
LEXINGTON MS
39095-3607
US

V. Phone/Fax

Practice location:
  • Phone: 662-834-1154
  • Fax: 662-834-0681
Mailing address:
  • Phone: 662-834-1154
  • Fax: 662-834-0681

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberR06886
License Number StateMS

VIII. Authorized Official

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