Healthcare Provider Details

I. General information

NPI: 1356555080
Provider Name (Legal Business Name): SUMNER DRUG STORE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/10/2007
Last Update Date: 09/29/2025
Certification Date: 09/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

108 N. COURT SQUARE
SUMNER MS
38957
US

IV. Provider business mailing address

108 N. COURT SQUARE
SUMNER MS
38957
US

V. Phone/Fax

Practice location:
  • Phone: 662-375-8813
  • Fax: 662-375-8883
Mailing address:
  • Phone: 662-375-8813
  • Fax: 662-375-8883

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberE-5254
License Number StateMS

VIII. Authorized Official

Name: SPENCER HUDSON
Title or Position: PHARMACIST
Credential:
Phone: 662-375-8813