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General NPI Number Information
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NPI Number | 1194889568
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Entity Type | Organization
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Legal Business Name | HOLLIS DISCOUNT PHARMACY, INC
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Dates
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Enumeration Date | 12/20/2006
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Last Update Date | 04/16/2023
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Provider Practice Location Address
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Address Line | 1008 CITY AVE N
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City | RIPLEY
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State | MS
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Zip | 38663-1413
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Country | US
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Telephone | 662-837-4774
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Fax |
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Provider Business Mailing Address
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Address Line | 1008 CITY AVE N
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City | RIPLEY
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State | MS
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Zip | 38663-1413
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Country | US
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Telephone | 662-837-4774
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Fax |
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Authorized Official
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Title or Position | CEO/PRESIDENT
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Name | MR. JIMMY L TUCKER
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Credential | RPH
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Telephone | 662-837-7323
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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 | 333600000X
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Taxonomy Name | Pharmacy
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License Number | MS1326
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License Number State | MS
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