Healthcare Provider Details

I. General information

NPI: 1881778330
Provider Name (Legal Business Name): LAB DISCOUNT DRUGS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/24/2006
Last Update Date: 10/05/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

923 WAYNE ST
WAYNESBORO MS
39367-2571
US

IV. Provider business mailing address

923 WAYNE ST
WAYNESBORO MS
39367-2571
US

V. Phone/Fax

Practice location:
  • Phone: 601-735-4444
  • Fax: 601-735-5885
Mailing address:
  • Phone: 601-735-4444
  • Fax: 601-735-5885

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number01624/01.1
License Number StateMS
# 2
Primary TaxonomyN
Taxonomy Code3336H0001X
TaxonomyHome Infusion Therapy Pharmacy
License Number01624/01.1
License Number StateMS

VIII. Authorized Official

Name: MR. WARREN E. HUTTO
Title or Position: PRESIDENT
Credential: R.PH.
Phone: 601-735-4444