Healthcare Provider Details

I. General information

NPI: 1952493579
Provider Name (Legal Business Name): LAWRENCE COUNTY DRUGS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/29/2006
Last Update Date: 12/21/2024
Certification Date: 12/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

422 E BROAD ST
MONTICELLO MS
39654
US

IV. Provider business mailing address

PO BOX 786
MONTICELLO MS
39654-0786
US

V. Phone/Fax

Practice location:
  • Phone: 601-587-4011
  • Fax:
Mailing address:
  • Phone: 601-587-4011
  • Fax: 601-587-0202

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number00760/01.1
License Number StateMS
# 2
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: RONEASA GARNER
Title or Position: OWNER
Credential:
Phone: 601-587-4011