Healthcare Provider Details

I. General information

NPI: 1063575371
Provider Name (Legal Business Name): OKOLONA DRUG CO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/18/2006
Last Update Date: 03/04/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 W MAIN ST
OKOLONA MS
38860-1425
US

IV. Provider business mailing address

210 W MAIN ST
OKOLONA MS
38860-1425
US

V. Phone/Fax

Practice location:
  • Phone: 662-447-5471
  • Fax: 662-447-5637
Mailing address:
  • Phone: 662-447-5471
  • Fax: 662-447-5637

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberE5837
License Number StateMS

VIII. Authorized Official

Name: MR. SIDNEY G MORGAN
Title or Position: PRESIDENTPHARMACIST
Credential: RPH
Phone: 662-447-5471