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General NPI Number Information
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NPI Number | 1497541775
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Entity Type | Organization
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Legal Business Name | STATE LINE DRUGS
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Dates
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Enumeration Date | 04/15/2025
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Last Update Date | 04/15/2025
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Provider Practice Location Address
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Address Line | 194 MAIN ST
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City | STATE LINE
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State | MS
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Zip | 39362-9600
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Country | US
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Telephone | 601-848-7866
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 159
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City | STATE LINE
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State | MS
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Zip | 39362-0159
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Country | US
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Telephone | 601-848-7866
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Fax | 601-848-7346
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Authorized Official
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Title or Position | OWNER
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Name | JAMES CHARLES SNYDER
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Credential | R,PH
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Telephone | 601-394-8264
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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 |
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License Number State |
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