Healthcare Provider Details

I. General information

NPI: 1780749739
Provider Name (Legal Business Name): TUNICA QUALITY DRUGS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/27/2006
Last Update Date: 06/30/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1068 HIGHWAY 61 N
TUNICA MS
38676
US

IV. Provider business mailing address

PO BOX 1229
TUNICA MS
38676-1229
US

V. Phone/Fax

Practice location:
  • Phone: 662-363-1540
  • Fax: 662-363-6706
Mailing address:
  • Phone: 662-363-1540
  • Fax: 662-363-6706

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number01141011
License Number StateMS

VIII. Authorized Official

Name: DWIGHT SOREY
Title or Position: VICE PRESIDENT
Credential:
Phone: 662-363-1540