Healthcare Provider Details

I. General information

NPI: 1952499881
Provider Name (Legal Business Name): THOMAS DRUG COMPANY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/10/2006
Last Update Date: 03/01/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

109 BALL AVE
TYLERTOWN MS
39667-2101
US

IV. Provider business mailing address

109 BALL AVE
TYLERTOWN MS
39667-2101
US

V. Phone/Fax

Practice location:
  • Phone: 601-876-3665
  • Fax: 601-876-9922
Mailing address:
  • Phone: 601-876-3665
  • Fax: 601-876-9922

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number01689/1.1
License Number StateMS

VIII. Authorized Official

Name: JENNIFER THOMAS
Title or Position: OWNER
Credential:
Phone: 601-876-3665