Healthcare Provider Details

I. General information

NPI: 1023031713
Provider Name (Legal Business Name): PEARL RIVER DRUG CO.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/25/2006
Last Update Date: 05/01/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

510 S MAIN ST
POPLARVILLE MS
39470
US

IV. Provider business mailing address

PO BOX 10 PO BOX 10
PICAYUNE MS
39466
US

V. Phone/Fax

Practice location:
  • Phone: 601-795-4239
  • Fax: 601-795-4941
Mailing address:
  • Phone: 601-795-4239
  • Fax: 601-795-4941

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number00558/01.1
License Number StateMS

VIII. Authorized Official

Name: ANDREW L FAILLA
Title or Position: OWNER/PRESIDENT
Credential: RPH
Phone: 601-798-4846