Healthcare Provider Details

I. General information

NPI: 1629192661
Provider Name (Legal Business Name): MIDTOWN DRUGS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/16/2007
Last Update Date: 07/22/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 NORTH LAMAR MIDTOWN DRUGS
OXFORD MS
38655
US

IV. Provider business mailing address

800 NORTH LAMAR MIDTOWN DRUGS
OXFORD MS
38655
US

V. Phone/Fax

Practice location:
  • Phone: 662-234-4419
  • Fax:
Mailing address:
  • Phone: 662-234-4419
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberE06127
License Number StateMS
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number01126
License Number StateMS

VIII. Authorized Official

Name: MR. STEPHEN ALEXANDER ROGERS
Title or Position: PHARMACIST & OWNER
Credential: PHARMACIST & OWNER
Phone: 662-234-4419