Healthcare Provider Details

I. General information

NPI: 1801553367
Provider Name (Legal Business Name): HOLLIS DISCOUNT PHARMACY, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/19/2021
Last Update Date: 11/19/2021
Certification Date: 10/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1008 CITY AVE N
RIPLEY MS
38663-1413
US

IV. Provider business mailing address

1008 CITY AVE N
RIPLEY MS
38663-1413
US

V. Phone/Fax

Practice location:
  • Phone: 662-837-7300
  • Fax: 662-837-3600
Mailing address:
  • Phone: 662-837-7323
  • Fax: 662-837-3600

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: JIMMY L TUCKER
Title or Position: CEO/PRESIDENT
Credential: RPH
Phone: 662-837-7323