Healthcare Provider Details

I. General information

NPI: 1255698908
Provider Name (Legal Business Name): RXS PM RETAIL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/19/2012
Last Update Date: 04/19/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2801 W MAIN ST
TUPELO MS
38801-3001
US

IV. Provider business mailing address

PO BOX 3308
TUPELO MS
38803-3308
US

V. Phone/Fax

Practice location:
  • Phone: 662-840-6411
  • Fax: 662-840-9918
Mailing address:
  • Phone: 662-840-6411
  • Fax: 662-840-9918

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number11270/1.1
License Number StateMS

VIII. Authorized Official

Name: MR. DOUGLAS M WRIGHT JR.
Title or Position: MANAGING MEMBER
Credential:
Phone: 662-680-3148