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General NPI Number Information
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NPI Number | 1346336757
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Entity Type | Organization
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Legal Business Name | GRIFFIN'S DISCOUNT PHARMACY INC
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Dates
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Enumeration Date | 10/04/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 339 E MADISON ST
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City | HOUSTON
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State | MS
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Zip | 38851-2322
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Country | US
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Telephone | 662-456-2501
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Fax | 662-456-4052
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Provider Business Mailing Address
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Address Line | 339 E MADISON ST
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City | HOUSTON
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State | MS
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Zip | 38851-2322
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Country | US
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Telephone | 662-456-2501
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Fax | 662-456-4052
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Authorized Official
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Title or Position | CO-OWNER
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Name | MR. KEN R FULLILOVE JR.
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Credential |
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Telephone | 662-456-2501
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number | 01477
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License Number State | MS
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