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General NPI Number Information
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NPI Number | 1275628851
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Entity Type | Organization
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Legal Business Name | MADISON DISCOUNT DRUGS, INC.
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Dates
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Enumeration Date | 10/03/2006
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Last Update Date | 11/20/2007
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Provider Practice Location Address
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Address Line | 980-A HIGHWAY 51
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City | MADISON
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State | MS
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Zip | 39110
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Country | US
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Telephone | 601-856-7111
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Fax | 601-856-1735
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Provider Business Mailing Address
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Address Line | PO BOX 1606
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City | MADISON
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State | MS
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Zip | 39130
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Country | US
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Telephone | 601-856-7111
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Fax | 601-856-1735
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Authorized Official
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Title or Position | PRESIDENT
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Name | DENNIS R REVES
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Credential |
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Telephone | 601-856-7111
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 002244
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License Number State | MS
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