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General NPI Number Information
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NPI Number | 1063557718
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Entity Type | Organization
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Legal Business Name | TLL&W INC DBA BUCKLEYS PHARMACY
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Dates
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Enumeration Date | 02/20/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 301 HOSPITAL DR
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City | CLEVELAND
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State | MS
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Zip | 38732-2358
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Country | US
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Telephone | 662-843-3654
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Fax | 662-843-3622
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Provider Business Mailing Address
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Address Line | 301 HOSPITAL DR
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City | CLEVELAND
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State | MS
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Zip | 38732-2358
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Country | US
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Telephone | 662-843-3654
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Fax | 662-843-3622
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Authorized Official
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Title or Position | PHARMACIST-OWNER
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Name | CULLIE TAYLOR ROBERTS JR.
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Credential | R.PH.
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Telephone | 662-843-3654
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 00509
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License Number State | MS
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