Healthcare Provider Details

I. General information

NPI: 1215032420
Provider Name (Legal Business Name): PETAL DRUG COMPANY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/13/2006
Last Update Date: 03/25/2024
Certification Date: 03/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 OLD RICHTON RD
PETAL MS
39465-2943
US

IV. Provider business mailing address

201 OLD RICHTON RD
PETAL MS
39465-2943
US

V. Phone/Fax

Practice location:
  • Phone: 601-545-3141
  • Fax: 601-544-7404
Mailing address:
  • Phone: 601-545-3141
  • Fax: 601-544-7404

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberE08925
License Number StateMS

VIII. Authorized Official

Name: MR. DAVID R RATCLIFF
Title or Position: PHARMACIST IN CHARGE
Credential: RPH
Phone: 601-545-3141