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General NPI Number Information
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NPI Number | 1629008859
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Entity Type | Organization
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Legal Business Name | POLKS CROSSGATES DISCOUNT DRUGS, INC.
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Dates
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Enumeration Date | 07/04/2006
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Last Update Date | 12/18/2012
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Provider Practice Location Address
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Address Line | 335 CROSSGATES BLVD
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City | BRANDON
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State | MS
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Zip | 39042-2602
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Country | US
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Telephone | 601-825-8660
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Fax | 601-825-6983
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Provider Business Mailing Address
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Address Line | 335 CROSSGATES BLVD
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City | BRANDON
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State | MS
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Zip | 39042-2602
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Country | US
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Telephone | 601-825-8660
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Fax | 601-825-6983
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Authorized Official
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Title or Position | PHARMACIST
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Name | MR. MICHAEL SCOTT BYRD
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Credential | R.PH.
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Telephone | 601-825-8660
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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 | 01619/01.2
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License Number State | MS
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Taxonomy #2
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 01619- 01.2
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License Number State | MS
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