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General NPI Number Information
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NPI Number | 1023031713
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Entity Type | Organization
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Legal Business Name | PEARL RIVER DRUG CO.
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Dates
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Enumeration Date | 07/25/2006
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Last Update Date | 05/01/2025
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Provider Practice Location Address
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Address Line | 510 S MAIN ST
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City | POPLARVILLE
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State | MS
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Zip | 39470
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Country | US
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Telephone | 601-795-4239
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Fax | 601-795-4941
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Provider Business Mailing Address
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Address Line | PO BOX 10 PO BOX 10
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City | PICAYUNE
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State | MS
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Zip | 39466
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Country | US
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Telephone | 601-795-4239
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Fax | 601-795-4941
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Authorized Official
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Title or Position | OWNER/PRESIDENT
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Name | ANDREW L FAILLA
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Credential | RPH
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Telephone | 601-798-4846
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336L0003X
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Taxonomy Name | Long Term Care Pharmacy
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 00558/01.1
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License Number State | MS
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