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General NPI Number Information
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NPI Number | 1629455431
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Entity Type | Organization
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Legal Business Name | OKOLONA PHARMACY LLC
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Dates
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Enumeration Date | 04/30/2015
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Last Update Date | 05/23/2023
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Provider Practice Location Address
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Address Line | 210 W MAIN ST
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City | OKOLONA
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State | MS
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Zip | 38860-1425
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Country | US
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Telephone | 662-447-0300
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Fax | 662-447-0130
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Provider Business Mailing Address
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Address Line | 210 W MAIN ST
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City | OKOLONA
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State | MS
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Zip | 38860-1425
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Country | US
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Telephone | 662-447-0300
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | TONY SMITH
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Credential |
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Telephone | 901-831-8669
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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 |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 14335/1.1
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License Number State | MS
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