Healthcare Provider Details

I. General information

NPI: 1457441941
Provider Name (Legal Business Name): POWELL DRUGS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/13/2006
Last Update Date: 05/18/2022
Certification Date: 05/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

519 MAIN ST
MT. OLIVE MS
39119
US

IV. Provider business mailing address

P. O. BOX 249
MT. OLIVE MS
39119
US

V. Phone/Fax

Practice location:
  • Phone: 601-797-3881
  • Fax: 601-797-4624
Mailing address:
  • Phone: 601-797-3881
  • Fax: 601-797-4624

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MR. WILLIAM HOMER POWELL
Title or Position: OWNER/PHARMACIST
Credential:
Phone: 601-797-3355