Healthcare Provider Details

I. General information

NPI: 1720009772
Provider Name (Legal Business Name): CITY REXALL DRUGS II INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/22/2006
Last Update Date: 04/21/2025
Certification Date: 04/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

349 S MAIN ST
PICAYUNE MS
39466-4415
US

IV. Provider business mailing address

349 S MAIN ST
PICAYUNE MS
39466-4415
US

V. Phone/Fax

Practice location:
  • Phone: 601-798-4761
  • Fax: 601-798-4761
Mailing address:
  • Phone: 601-798-4761
  • Fax: 601-798-4761

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number00179/1.1
License Number StateMS

VIII. Authorized Official

Name: STEPHEN PISARICH
Title or Position: PHARMACIST
Credential:
Phone: 228-861-5076