Healthcare Provider Details

I. General information

NPI: 1356477863
Provider Name (Legal Business Name): JOHNS' DISCOUNT DRUGS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/26/2007
Last Update Date: 03/04/2022
Certification Date: 03/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

410 W MAIN AVE
LUMBERTON MS
39455-2437
US

IV. Provider business mailing address

410 W MAIN AVE
LUMBERTON MS
39455-2437
US

V. Phone/Fax

Practice location:
  • Phone: 601-796-4761
  • Fax: 601-796-4764
Mailing address:
  • Phone: 601-796-4761
  • Fax: 601-796-4764

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number920IJL
License Number StateMS

VIII. Authorized Official

Name: BARRY LEWIS WAITS
Title or Position: PHARMACIST
Credential:
Phone: 601-796-4761