Healthcare Provider Details

I. General information

NPI: 1740556646
Provider Name (Legal Business Name): RXS TUPELO, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/26/2012
Last Update Date: 04/19/2022
Certification Date: 04/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2801 WEST MAIN ST. SUITE A
TUPELO MS
38801
US

IV. Provider business mailing address

2801 W MAIN ST STE A
TUPELO MS
38801-3001
US

V. Phone/Fax

Practice location:
  • Phone: 662-620-6400
  • Fax:
Mailing address:
  • Phone: 662-620-6400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number11167/1.1
License Number StateMS

VIII. Authorized Official

Name: MR. DOUGLAS M. WRIGHT JR.
Title or Position: MANAGING MEMBER
Credential:
Phone: 662-840-6411